Rheumatoid arthritis (RA)

Updated

September 22, 2026

What is RA?

An auto-immune systemic disease. Requires life-long treatment. Individual patients with RA appear to have different pathogenic mechanisms, due to different treatment response. Two major “types”: seropositive and seronegative, with seropositive presenting more severe symptoms.

Risk factors

  • First-degree relative with RA
  • Gene HLA-DR
  • Smoking
  • Overweight
  • Infections

What are the symptoms?

Typical patient

  • Age 30-70
  • 70% women
  • Symmetrical polyarthritis of hands and feet.
  • Common to have morning stiffness lasting more than 30 minutes.

Diagnosis

  • Number and location of affected joints
  • Duration of disease >= 6 weeks
  • Acute-phase reactants
  • X-ray for bone erosion
  • Serum samples to determine seropositive/seronegative
    • Rheumatiod factor (RF)
    • Anti-citrullinated protein antibodies (ACPAs)

How can it be treated?

  • DMARDs (Disease-Modifying Antirheumatic Drugs)
    • Conventional
      • Methotrexate (folate antagonist, L04AX03)
        • Typical treatment, 33% response rate.
      • Leflunomide (L04AK01)
      • Sulfasalazine (A07EC01)
      • Hydroxychloroquine (P01BA02)
    • Biologic (either alone or combo with conventionals)
      • Anti TNF-alpha
        • Adalimumab (L04AB04)
        • Certolizumab pegol (L04AB05)
        • Etanercept (L04AB01)
        • Golimumab (L04AB06)
        • Infliximab (L04AB02)
      • Anti IL6
        • Tocilizumab (L04AC07)
        • Sarilumab (L04AC14)
      • B-cell depletion
        • Rituximab (L01FA01)
      • T-Cell co-stimulatory inhibitor
        • Abatacept (L04AA24)
    • Targeted synthetic
      • JAK inhibitor
        • Tofacitinib (L04AF01)
        • Baricitinib (L04AF02)
        • Upadacitinib (L04AF03)

References

  • https://www.nejm.org/doi/full/10.1056/NEJMra2103726
  • https://www.youtube.com/watch?v=e_NZk8nFSPA