Rheumatoid arthritis (RA) is a systemic, chronic, autoimmune, inflammatory disease. It is characterized by polyarticular and symmetrical inflammation of small and large joints, with possible systemic involvement at any time during its evolution.
Rheumatology specialists state that this pathology affects 0.5-1% of the Spanish population. Like most autoimmune diseases, rheumatoid arthritis occurs more frequently in women. It has a higher incidence between 40 and 60 years of age.
What are the causes of rheumatoid arthritis?
Due to the great diversity of mechanisms acting together or sequentially, the cause of rheumatoid arthritis is complex and not known exactly. Its etiopathogenesis is considered to be the result of the interaction of a triggering antigen and a predisposing genetic basis.
How does rheumatoid arthritis appear?
From the early stages of the disease, rheumatoid arthritis significantly affects the daily activities of those who suffer from it. In most patients, the disease presents a chronic fluctuating course which, if left untreated, follows a progressive course, leading to destruction and disability of the affected joints.
The main symptoms at the onset of the disease are pain, morning stiffness, and swelling of many joints. Morning stiffness is defined as “slowness or difficulty in moving the joints when getting out of bed or after remaining in one position for too long, which improves with movement”.
It mainly affects the metacarpo-phalangeal, proximal interphalangeal joints of the fingers, wrists and metatarsophalangeal joints of the toes. Other joints that are also commonly affected are elbows, shoulders, ankles and knees.
What is the best treatment for rheumatoid arthritis?
Treatment of rheumatoid arthritis should be aimed at decreasing inflammatory activity, preventing progression of joint damage and its consequences. The ideal goal of treatment is to achieve remission of the disease or to obtain the greatest possible control of the activity.
There are different types of disease-modifying drugs, known as DMARDs: synthetic and biologic. Biologic DMARDs, which were marketed later than the synthetic ones, represented a major advance in the management of rheumatoid arthritis.
Early treatment of rheumatoid arthritis with this type of drug is able to induce remission in a considerable proportion of patients, 50-60%, prevent the development of radiographic lesions or halt their progression. However, there are up to 15-20% of patients in whom this treatment does not work, as it eventually loses its efficacy over time or is associated with intolerable adverse effects.
There are other biologic drugs under investigation or not yet approved in Europe that could have promising results. The development of cellular and molecular biology in recent decades has led to advances in the understanding of the biological basis of rheumatoid arthritis and has brought about a radical change in the development of new therapies. Despite this progress, the therapies currently available are only partially effective and costly. Moreover, they are not without serious side effects, so that, taken together, the treatment of rheumatoid arthritis cannot be considered satisfactory and the identification of new therapies remains necessary.