Rheumatoid arthritis (RA) is a prevalent immune-mediated inflammatory disease that affects millions of people worldwide, causing pain, swelling, and stiffness in the joints. Without effective treatment, it can lead to significant joint damage, disability, and work loss due to chronic inflammation of the joint lining.
However, over the past 25 years, the management of RA has undergone a revolutionary transformation, leading to higher levels of disease remission and better long-term outcomes. This improvement is attributed to early and aggressive pharmacological intervention, a wide range of treatment options, enhanced understanding of the disease’s biological processes, and the development of new drugs for RA.
In a recent article published in BMJ 2024, Philip Brown, an academic rheumatology trainee, Arthur G Pratt, an academic rheumatologist, and Kimme L Hyrich, another academic rheumatologist, provided an overview of these developments from a historical perspective, focusing on newer, targeted treatments in an ever-evolving landscape. The review also highlighted ongoing areas of debate and unmet needs, including the challenges faced by patients with persistent, difficult-to-treat disease despite recent advances.
The authors discussed personalized, strategic approaches to individual patients, the role of imaging in clinical decision making, and the goal of sustained, drug-free remission and disease prevention in the future. They emphasized the importance of addressing these areas to further enhance the management of RA and improve patient outcomes.
RA commonly presents with pain, swelling, and stiffness of synovial joints, particularly affecting the hands and feet across the metacarpophalangeal and metatarsophalangeal joints. Diagnosis is clinical, based on the pattern and nature of joint involvement, and is supported by the presence of autoantibodies and evidence of systemic inflammation. For research purposes, the disease is classified according to the 2010 European Alliance of Associations for Rheumatology/American College of Rheumatology criteria.
