Rheumatoid Arthritis

• Rheumatoid arthritis (RA), an autoimmune condition, is a chronic inflammatory polyarthritis.

• Natural history studies of Rheumatoid arthritis suggests that RA follows one of three courses

  • Monocyclic in 20% of people initially diagnosed with Rheumatoid arthritis.

  • Polycyclic in 70% (i.e., fluctuating levels of disease activity).

  • Progressive and unremitting condition in 10%.

Another natural history study found that 75% of people with Rheumatoid arthritis experienced remission after five years.

• Historically, pharmacologic treatment of Rheumatoid arthritis has traditionally followed the pyramid approach. That is, treatment starts with corticosteroids/non-steroidal anti-inflammatory drugs, then progresses to disease-modifying antirheumatic drugs (DMARD) and finally to biologic response modifiers (BRM) if persons are non-responsive to the previous drugs. Today, a more aggressive treatment approach is being advocated for people with early Rheumatoid arthritis, with prescription of DMARDs within three months of diagnosis.
   

• Risk factors

  • A range of environmental and genetic variables have been evaluated as potential risk factors for Rheumatoid arthritis (e.g. hormonal exposures, tobacco use, dietary components, HLA genotype, and microbial exposures), but to date no definitive risk factors for Rheumatoid arthritis have been identified.

  • Of the environmental factors examined, the most consistent evidence exists for an association between tobacco use and Rheumatoid arthritis; most studies of this risk factor have found a history of smoking is associated with Rheumatoid arthritis onset with increased risks .

  • The role of the following four estrogenic factors in Rheumatoid arthritis etiology has been studied extensively:

    • Oral contraceptives(OC) — Early studies found a decreased risk of RA among women who had ever used OCs.

    • Hormone replacement therapy (HRT)

    • Live birth history — Most studies have found that women who have never had a live birth have a slight to moderately increased risk of Rheumatoid arthritis.

    • Breastfeeding — The most recent studies have found that Rheumatoid arthritis is less common among women who breastfeed; this is in contrast with earlier studies which found an increased risk associated with breastfeeding.

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