Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. It is a chronic inflammatory disorder caused in many cases by the interaction between genes and environmental factors, including tobacco, that primarily involves synovial joints. It typically starts in small peripheral joints, is usually symmetric, and progresses to involve proximal joints if left untreated. Joint inflammation over time leads to the destruction of the joint with loss of cartilage and bone erosions. RA with a symptom duration of fewer than six months is defined as early RA, and when the symptoms have been present for more than six months, it is defined as established RA. RA, if untreated, is a progressive disease with morbidity and increased mortality. There is no pathognomonic laboratory test for rheumatoid arthritis, which makes the diagnosis of this disease challenging in the early stages. A comprehensive clinical approach is required to make the diagnosis and prevent debilitating joint damage. The treatment of patients with rheumatoid arthritis requires both pharmacological and non-pharmacological therapy. Today, the standard of care is early treatment with disease-modifying anti-rheumatic drugs. Despite treatment, many patients progress to disability and suffer significant morbidity over time. A comprehensive pharmacological and non-pharmacological treatment (physical therapy, counseling, and patient education) is required to improve clinical outcomes.