Rheumatoid arthritis (RA) is a chronic inflammatory disease that mostly affects the joints, among other tissues.

  • RA is characterized by a symmetrical and bilateral inflammation of the synovium of joints, with progressive erosion and destruction of the affected joints.
  • Virtually every joint can be affected apart from the distal interphalangeal joints (DIP).
  • Epidemiology. Population prevalence of 0.5% to 1% and an annual incidence of 12-1,200 per 100,000 population. Females are more commonly affected.
  • Etiology. RA is a complex multifactorial (genetic and environmental) disease with an uncertain etiology.
    • Environmental. Associated with smoking and periodontitis.
    • Genetics. HLA-DR1 and HLA-DR4 genes.

Clinical presentation

Course pattern

RA typically appears in one of three course patterns:

  1. Single attack with complete remission (monocyclic)
  2. Remittent attacks with complete or incomplete remission periods (polycyclic, most common)
  3. Progressive disease without remissions

Disease course

  • Early disease presents with general symptoms (weakness, fever, malaise), and joint swelling and pain. Synovitis and joint erosion are evident in radiographic

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