Rheumatoid Arthritis (RA)

General Information

Chronic autoimmune inflammatory condition targeting joints

Risk Factors: 40-60 y/o, women, genetic predisposition, Class II HLA-DRB1 alleles, smoking, environmental (silica, asbestos)

Evaluation

Symptoms:
- Bilateral joint deformation and accompanying pain
  - Most commonly affected joints: hands, wrists, feet, cervical spine
Thrombocytosis, serology (+), osteopenia

Pathophysiology

Inflammation of the joint capsule’s synovial membrane progresses to joint deformity, movement restriction, severe disability
- Originates in small peripheral joints
Patients often test positive via ELISA for antibodies to cyclic citrullinated peptides, or anti-CarP antibodies → are produced by plasma cells within synovial capsule, recruit cytokines and inflammatory factors leading to bone erosions

Complications

Osteopenia, osteoporosis

Venous thromboembolic diseases

Comorbidies secondary to systemic inflammation

NSAIDs: pain relief
Corticosteroids (e.g., prednisone): reduce inflammation
Conventional disease-modifying antirheumatic drugs/DMARDs (e.g., methotrexate, AZA, HCQ): slow progression of RA, minimize permanent damage
- Triple therapy: methotrexade, HCQ, AZA
Newer DMARDs/biologic agents (e.g., TNFs like infliximab): pair with conventional DMARD
Abatacept: inhibits T-cell activation