Rheumatoid Arthritis

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The one-minute consultant answer

Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory polyarthritis characterised by autoimmune-driven synovial proliferation that erodes cartilage and bone. The classical pattern targets the small joints of the hands and feet — metacarpophalangeal joints (MCPs), proximal interphalangeal joints (PIPs), wrists and metatarsophalangeal joints (MTPs) — with morning stiffness lasting more than one hour. The 2010 ACR/EULAR classification criteria combine joint involvement, serology (RF and anti-CCP), acute-phase reactants (CRP or ESR) and symptom duration to identify definite RA with a score of 6 or more out of 10 [1]. Management follows the treat-to-target paradigm: aim for remission or low disease activity, monitor every 1 to 3 months with a composite score (DAS28, CDAI or SDAI), and escalate if the target is not reached within 3 to 6 months [3][4]. Methotrexate is the anchor DMARD and first-line therapy; if the target is not met, add or switch to a biologic (anti-TNF, anti-IL-6 receptor, anti-CD20) or a JAK inhibitor. This is a systemic disease — extra-articular manifestations and comorbidities (cardiovascular disease, interstitial lung disease, osteoporosis, infection risk) determine mortality as much as joint damage does.

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