Rheumatoid arthritis (RA) is a systemic autoimmune disease characteriz
ed by synovitis and joint erosions. It affects approximately 1% of the
adult population in a female/male ratio ranging from 2:1 to 4:1. RA i
s an insidious disease, typically having an onset of symmetric joint s
welling and reaching a peak incidence in the fourth and fifth decades.
Extraarticular manifestations include pulmonary, ocular, and vascular
disease. The etiology of RA remains unknown. Attempts to discover inf
ectious causes have proven unsuccessful, although environmental influe
nces may trigger a response leading to the development of this autoimm
une disease. Genetic associations have been identified, particularly w
ith the major histocompatibility complex class II antigens. Furthermor
e, twin studies have shown a 30%-50% concordance rate for monozygotic
twins. Approximately 70%-80% of patients with RA have rheumatoid facto
r present in the blood, although its role remains unclear. Hormonal st
atus may influence RA. The majority of RA patients are women, and in 7
5% of them, the disease improves during pregnancy. RA has significant
financial and social implications associated with treatment costs, los
t wages, disability, and increased mortality. Mainstays of medical the
rapy have included nonsteroidal anti-inflammatory and immunosuppressiv
e agents, such as prednisone and methotrexate. Recent advances in the
treatment of RA include specific inhibitors of cyclooxygenase II, T ce
lls, blood vessels, cytokines (such as tumor necrosis factor-alpha [TN
F-alpha] or interleukin-1 [IL-1]), and adhesion molecules. Additional
studies are ongoing with combination interventions. It is anticipated
that a better understanding of the basic pathophysiologic mechanisms c
ritical in RA pathogenesis will provide more precise and efficacious t
herapy.