Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of connective tissue, primarily affecting joints in a symmetrical pattern, leading to their progressive destruction, deformation, and functional impairment. It is classified as a systemic disease since extra-articular organs can also be involved.

Epidemiology

• Prevalence in the general population: approximately 0.5–1%.
• Women are affected 2–3 times more often than men.
• Peak incidence: 30–50 years, but the disease can occur at any age, including childhood (juvenile idiopathic arthritis).

Etiology and Pathogenesis

The exact cause is unknown, but the disease is multifactorial:

• Genetic predisposition (HLA-DR4, HLA-DR1).
• Immune mechanisms: activation of T- and B-lymphocytes, production of rheumatoid factor (IgM against Fc fragment of IgG), anti-CCP antibodies.
• Environmental factors: infections, smoking, hormonal influences.

The key link is chronic autoimmune inflammation with the formation of granulation tissue (pannus), which destroys cartilage and bone.

Clinical Manifestations

Articular

• Symmetrical polyarthritis of small joints of hands and feet.
• Morning stiffness lasting more than 30 minutes.
• Pain, swelling, restricted mobility.
• Progressive deformities (“swan neck,” “buttonhole,” ulnar deviation).

Extra-articular

• Subcutaneous rheumatoid nodules.
• Pulmonary involvement (interstitial fibrosis, pleuritis).
• Vascular manifestations (vasculitis).
• Cardiac involvement (pericarditis, increased risk of atherosclerosis).
• Sjögren’s syndrome (dry eyes and mouth).

Diagnosis

Diagnosis is based on clinical, laboratory, and imaging data.

• Clinical: symmetrical polyarthritis, morning stiffness > 6 weeks.
• Laboratory: rheumatoid factor, anti-CCP antibodies, elevated ESR, CRP.
• Imaging: X-ray (erosions, osteoporosis, joint space narrowing), US/MRI (synovitis, early erosive changes).

Diagnostic criteria: ACR/EULAR 2010.

Treatment

Goal: achieve remission or low disease activity.
1.    Pharmacological 
2.    Non-pharmacological measures 

• physiotherapy, exercise, occupational therapy, 
• psychological support, smoking cessation, 
• surgical interventions (joint replacement) for severe deformities.

Prognosis

• Without treatment — progressive disability.
• Modern “treat-to-target” strategies significantly improve outcomes.
• Early initiation of methotrexate or biologics can lead to sustained remission.

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