Rheumatoid Arthritis (RA) is a systemic inflammatory disease that
predominantly manifests in the synovial membrane of diarthrodial joints. The
inflammation develops in a genetically predispose host.
Exogenous events that
precipitate the development of the disease have not been identified.
chronic inflammatory process induces changes in the cellular composition and
the gene expression profile of the synovial position and the gene expression
profile of the synovial membrane, resulting in hyperplasia of synovial
fibroblasts and structural damage of cartilage, bone, and ligaments.
disease affecting a variety of organs occurs in the majority of the patients.
It’s a significant factor in morbidity and mortality of people with RA. The
severity of RA encompasses a wide spectrum, ranging from self-limiting disease
to chronic progressive disease, causing varying degrees of joint destruction
and clinically evident extra-articular organ involvement. This clinical
heterogeneity is determined by genetic and environmental factors that control
the progression, degree, and pattern of the inflammation.
Arthritis has a worldwide distribution and affects all ethnic groups. The
disease can occur at any age, but its prevalence increases with age, the peak
incidence is between the fourth and sixth decades RA is a disease of an
aberrant immune response in a genetically predisposed host that leads to
chronic progressive synovial inflammation and destruction of the joint
Research efforts have shed light on the genetic factors, the
immunoregulatory defects, and the effector mechanisms leading to tissue injury.
Although the impact of genetic factors is obvious, the genetic basis is complex
and not sufficient to explain the triggering of the immune insult.
Precipitating factors have not been identified, and it remains a matter of
debate whether the disease is triggered by an exogenous infectious agent, a
breach in tolerance leading to classical autoimmunity, or merely stochastic
events that have accumulated with age.
Arthritis is a Chronic Disorder for which there is no known cure. Fortunately,
in the last few years, a shift in strategy toward the earlier institution of
disease modifying drugs and the availability of new classes of medication have
greatly improved the outcomes that can be expected by most patients.
optimal treatment of RA requires a comprehensive program that combines medical,
social and emotional support for the patient. Treatment options include
medications, reduction of joint stress, physical and occupational therapy, en
three general classes of drugs commonly used in the treatment of rheumatoid arthritis:
nonsteroidal anti-inflammatory agents (NSAIDS), CORTICOSTEROIDS, AND DISEASE
MODIFYING ANTI-RHEUMATIC DRUGS(DMARDs). NSAIDs and corticosteroids have a short
onset of action while DMARDs can take several weeks or months to demonstrate a
include methotrexate, sulfasalazine, leflunomide(arava) etanercept(Enbrel)
infliximab(Remicade) adalimumab(Humira), certolizumab pegol(Cimzia),
rituximab(rituxan) antimalarials(plaquenil) and others. Also, immunomodulators
are occasionally used including azathioprina (Imuran) and cyclosporine.
Analgesics are also sometimes helpful in decreasing pain until DMARDs take