Rheumatoid Arthritis

• Rheumatoid arthritis (RA) affects all ethnic groups and has a wide age range of onset. The average ages at diagnosis for women and men are approximately 50 and 60 years, respectively. In general, the prevalence across the world is estimated to be between 0.5% and 1%. Women are approximately three times as likely as men to develop RA. In addition, in some populations, such as indigenous peoples of the Americas, the prevalence range is higher, on the order of 5–7%. • RA typically affects distal joints (e.g., hands, wrists, and feet) in a symmetrical polyarthritis, and there is increasing awareness that tenosynovitis is a manifestation of RA Early disease, however, may be apparent in only a few joints. • The onset of RA is usually subacute in nature, with insidious accumulation of fatigue, joint pain, stiffness, and swelling. However, waxing and waning symptoms and findings can occur, especially in early phases of the disease when RA can demonstrate “palindromic” features or a migratory oligoarthritis. In other cases, the onset of disease is explosive, with the development of severe symptoms over only a few days. • If untreated (or undertreated), RA can lead to progressive joint damage and disability. • Autoantibodies, including rheumatoid factor (RF) and antibodies to cyclic citrullinated protein antigens (ACPA), are present in up to 80% of patients. A growing number of other autoantibodies are now described, including antibodies to carbamylated proteins. • For patients in whom an inflammatory arthritis is present in an RA-like pattern but autoantibodies are not detected, the term “seronegative RA” can be used. In such cases, however, it is important not to overlook other forms of arthritis such as microcrystalline disease, spondyloarthritis, virus-associated arthritis, or paraneoplastic syndromes. • The principal goals of modern treatment is the prevention of joint damage and to improve quality of life. • Treatment approaches now emphasize early diagnosis and interventions designed to suppress joint inflammation. Treat-to-target approaches in which frequent visits to gauge disease activity and adjust medications accordingly for the purpose of achieving low disease activity or even remission are standard-of-care.