Rheumatoid Arthritis

Summary
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease and the hallmark of this condition is persistent symmetric polyarthritis (synovitis) that affects the hands and feet, though any joint lined by a synovial membrane may be involved. If insufficiently treated, RA can lead to accumulating joint damage and irreversible disability 1. The prevalence of RA is estimated at 1% in most developed countries, with a frequency ranging from less than or equal to 0.1% to 1.9% in surveys from different parts of the world. In China, the prevalence of RA is about 0.42%2.
Causes

The pathogenesis of RA is still unknown, and the initiation of RA is a combination of genetic and stochastic events. Susceptibility to RA is clearly defined by a pattern of inherited genes, and the environmental stimuli including smoking, and mucosal surface innate immunity also contribute.

Symptions

Rheumatoid arthritis has diverse clinical manifestations, featuring slow insidious onset in the majority and acute onset in the minority of patients, with onset and remission alternating. The main symptoms are symmetrical and persistent joint swelling and pain, often accompanied by morning stiffness. The most common affected joints are proximal interphalangeal joints, metacarpophalangeal joints, wrist, elbow and toe joints; at the same time, the cervical spine, temporomandibular joint, sternoclavicular and acromioclavicular joints may also be involved. The severe and advanced patients may have "swan neck" and "Button Flower"-like deformity of fingers, joint stiffness and subluxation of the metacarpophalangeal joint, manifested as ulnar deviation of the metacarpophalangeal joint. Extra-articular involvement of organs such as the skin, heart, lungs, and eyes can be significant 1,3.

Treatment

The treatment goal is to control the disease, improve the function and prognosis. Treat to target strategy should be applied and the principle early intervention, combination therapy and individualized therapy should be emphasized. Current treatment options include NSAIDs, csDMARDs, bDMARDs and tsDMARDs 1,3.
  

1.  Smolen, J.S., et al., Rheumatoid arthritis. Nat Rev Dis Primers, 2018. 4: p. 18001.
2.  Jin, S., et al., Chinese Registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis. Arthritis Res Ther, 2017. 19(1): p. 251.
3.  Smolen, J.S., D. Aletaha, and I.B. McInnes, Rheumatoid arthritis. Lancet, 2016. 388(10055): p. 2023-2038.

CP-85681 Approved date 2019-4-11