is a chronic multisystem disease of unknown cause and typically involves peripheral joints in a symmetric distribution. RA is prevalent throughout the world and affects all races. Women are affected approximately three times more than men. The onset is most frequent during the fourth and fifth decades of life. Significant advancements have been made in the understanding of the inflammatory events leading to joint injury and extraarticular manifestations.
The goal of the treatment is to reduce pain and swelling to preserve joint function and activities of daily living. Medications include a broad range of substances from anti inflammatory drugs to steroids to disease modifying anti rheumatic drugs (DMARDs). DMARDs consist of consist of antimalarials, sulfasalazine, methotrexate, cyclosporine and gold salts. Cytotoxic agents like azathioprine and cyclophosphamide are also useful in certain resistant cases but are placed in a separate category because of their toxicity and safety concerns. Newer biologic agents that have shown good promise belong to TNF neutralizers.
Surgery is required to correct deformities in severely damaged joints.
Pain interventions play a significant role in altering the course of the disease and to decrease the pharmacological load. Interventions vary from intraarticular therapy to neuromodulation techniques and give better results if started in the earlier part of the disease. Extraarticular manifestations like fibromyalgia are also best managed by the pain physician with the use of certain minor and minimally invasive interventions.
Besides rheumatoid arthritis certain other conditions are also known to produce joint disabilities. Major ones among these are ankylosing spondylitis, psoriatic arthritis, reiter’s syndrome, arthritis associated with ulcerative colitis, crohn’s disease, arthritis caused by deposition of calcium pyrophosphate, hydroxyapatite arthropathy and gout.