24th February 2025

Overview of RA

RA is an autoimmune disease that typically affects patients from their fifth decade and, like most autoimmune diseases, has a 3:1 female-to-male predominance.

The pathophysiology is due to an immune response triggered between both B and T lymphocytes and fibroblasts of the synovial membranes, generating an inflammatory cascade mediated by TNF-ɑ and IL-6. The deposition of immune complexes causes cartilage degradation and, thus, joint pain. In certain cases, the inflammatory cascade is so pronounced that multi-system extra-articular manifestations can occur and so close monitoring for complications is required.

The treatment consists of combinations of immunosuppressive therapies, known as disease-modifying antirheumatic drugs (DMARDs, such as methotrexate) and biologics (first line are anti-TNF-ɑ) to dampen down the immune response and thus the symptomology, though they all require close monitoring and do not come without their own side effects.