Shakeel Laiba, Shaukat Ayesha, Khaliq Nawal, Kashif Aayat, Mujeeb Azka, Adnan Zahabia, Taj Javeria, Akilimali Aymar
Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
Ann Med Surg (Lond). 2025 Jan 7;87(2):696-710. doi: 10.1097/MS9.0000000000002890. eCollection 2025 Feb.
Rheumatoid arthritis (RA) is a prevalent autoimmune disorder marked by chronic inflammatory arthritis and systemic effects. The etiology of RA is complex, involving genetic factors like HLA-DR4 and HLA-DR1, as well as environmental influences, particularly smoking, which heightens disease risk. Affecting approximately 1% of the global population, RA is associated with considerable morbidity and mortality, with its prevalence expected to increase due to demographic shifts, especially in certain regions. RA symptoms commonly manifest between ages 35 and 60 but can also affect children under 16 in cases of juvenile RA. Symptoms include prolonged joint stiffness, pain, fatigue, and, in advanced cases, joint deformities. Current treatment approaches involve disease-modifying antirheumatic drugs, biologics, and glucocorticoids to manage symptoms and slow disease progression, though these treatments often present limitations due to adverse effects and varied patient response. The identification of genetic markers, such as HLA-DRB1 and PTPN22, supports the growing emphasis on personalized treatment strategies that account for genetic and lifestyle factors. Non-pharmacological approaches - diet adjustments, physical activity, and stress management - are increasingly valued for their complementary role in RA management. Lifestyle interventions, including whole-food, plant-based diets and physical therapy, show promise in reducing inflammation and improving joint function. Technological advancements, like telemedicine, mobile health applications, and artificial intelligence, are enhancing RA diagnosis and treatment, making care more precise and accessible. Despite these advancements, RA remains incurable, necessitating continued research into novel therapeutic targets and approaches. A comprehensive, patient-centered approach that integrates lifestyle modifications, preventive strategies, and innovative treatments is essential for improving RA management and patient outcomes.
类风湿性关节炎(RA)是一种常见的自身免疫性疾病,其特征为慢性炎症性关节炎和全身影响。RA的病因复杂,涉及HLA - DR4和HLA - DR1等遗传因素以及环境影响,尤其是吸烟,吸烟会增加患病风险。RA影响全球约1%的人口,与相当高的发病率和死亡率相关,由于人口结构变化,尤其是在某些地区,其患病率预计还会上升。RA症状通常在35至60岁之间出现,但幼年型RA也可影响16岁以下儿童。症状包括关节长期僵硬、疼痛、疲劳,在病情晚期还会出现关节畸形。目前的治疗方法包括使用改善病情抗风湿药、生物制剂和糖皮质激素来控制症状并减缓疾病进展,不过这些治疗常常因不良反应和患者反应各异而存在局限性。HLA - DRB1和PTPN22等遗传标志物的识别支持了越来越强调考虑遗传和生活方式因素的个性化治疗策略。非药物方法——饮食调整、体育活动和压力管理——因其在RA管理中的辅助作用而越来越受到重视。生活方式干预,包括全食物、植物性饮食和物理治疗,在减轻炎症和改善关节功能方面显示出前景。远程医疗、移动健康应用和人工智能等技术进步正在加强RA的诊断和治疗,使医疗更加精准且可及。尽管有这些进展,RA仍然无法治愈,因此需要继续研究新的治疗靶点和方法。一种综合的、以患者为中心的方法,将生活方式改变、预防策略和创新治疗相结合,对于改善RA管理和患者预后至关重要。