Rheumatoid arthritis (RA) is a long-term autoimmune disorder and chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis. RA affects about 1 percent of adults, but the frequency varies depending upon the population studied. Onset is more frequent in women during middle age.
The major clinical features of RA is the articular manifestations. The disease onset in RA is usually insidious, with the predominant symptoms being pain, stiffness especially morning stiffness, and swelling of many joints and fatigue, fever, and weight loss.
Typically, the metacarpophalangeal (MCP) and proximal (PIP) joints of the fingers, the interphalangeal joints of the thumbs, the wrists, and the metatarsophalangeal (MTP) joints of the toes are sites of arthritis early in the disease. Other synovial joints of the upper and lower limbs, such as the elbows, shoulders, ankles, and knees are also commonly affected.
It is the most common form of chronic inflammatory arthritis and often results in joint damage and physical disability.
Because RA is a systemic disease, may result in a variety of extra-articular manifestations, including fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis, and hematologic abnormalities, Episcleritis, scleritis, splenomegaly, Sjögren's syndrome, and renal disease may occur during the course of the disease.
Most patients with extra-articular features of RA have longstanding and severe disease. RA patients will often present with elevated nonspecific inflammatory markers such as an ESR or CRP. Detection of serum RF and anti-CCP antibodies are important in differentiating RA from other polyarticular diseases, although RF lacks diagnostic specificity and may be found in association with other chronic inflammatory diseases in which arthritis figures in the clinical manifestations.
RF or anti-CCP antibodies has prognostic significance, with anti-CCP antibodies showing the most value for predicting worse outcomes.
The 2010 classification criteria for RA were developed primarily for the identification for research purposes of patients with RA who are at high risk of persistent symptoms and joint injury unless treated with disease-modifying antirheumatic drugs (DMARDs). These criteria have replaced the 1987 criteria, which were based only upon patients with established disease.
The goals of treatment are to reduce pain, decrease inflammation, and improve a person's overall functioning. Disease-modifying treatment has the best results when it is started early and aggressively.
Treatment for all patients should be based on a disease activity target—either remission or low disease activity. In all patients with active RA, we recommend treatment with a DMARD, rather than use of anti-inflammatory agents and/or glucocorticoids alone and delay of DMARD therapy.
Most patient demands the use of a combination DMARD regimen that may vary in its components over the treatment course depending on fluctuations in disease activity and emergence of drug-related toxicities and comorbidities.
Synovial thickening of the metacarpophalangeal joint