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Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that primarily affects the synovial joints, producing symmetrical polyarthritis, pain, swelling, stiffness, and progressive joint destruction. It commonly involves the small joints of the hands and feet and may also produce extra-articular manifestations. Early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) are important to prevent deformity and long-term disability.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by persistent synovial inflammation, progressive cartilage destruction, bone erosion, and joint deformity. It most commonly presents as a symmetrical inflammatory polyarthritis, particularly involving the metacarpophalangeal, proximal interphalangeal, wrist, and metatarsophalangeal joints. Typical symptoms include joint pain, swelling, prolonged morning stiffness, fatigue, and reduced function. With progression, patients may develop characteristic deformities such as ulnar deviation, swan-neck deformity, boutonnière deformity, and Z-thumb. The cervical spine and large joints may also be affected in advanced disease. Diagnosis is based on clinical findings supported by laboratory investigations such as rheumatoid factor, anti-CCP antibodies, ESR, and CRP. Radiographs may demonstrate soft-tissue swelling, periarticular osteopenia, joint-space narrowing, and marginal erosions. Ultrasound and MRI can identify synovitis and early erosive changes. Management requires a multidisciplinary approach. The mainstay of treatment is early initiation of DMARD therapy, commonly methotrexate, with escalation to combination therapy, biologic agents, or targeted synthetic DMARDs when required. Analgesics, NSAIDs, short courses of corticosteroids, physiotherapy, occupational therapy, and lifestyle measures may be used as adjuncts. Orthopaedic intervention may be required for advanced disease with severe pain, deformity, tendon rupture, instability, or joint destruction. Procedures may include synovectomy, tendon reconstruction, arthrodesis, and joint replacement. The overall goal is to control inflammation, prevent structural damage, preserve function, and maintain quality of life.

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