Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune synovitis. Activated T and B cells and cytokines such as tumour necrosis factor (TNF) and interleukin-6 sustain inflammation within the synovial lining. The resulting pannus behaves like an invasive inflammatory tissue: it degrades cartilage and erodes adjacent bone, eventually producing reduced range of motion, deformity and loss of function. This explains a central treatment distinction. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and stiffness, but they do not stop the immune process or prevent erosions. Disease-modifying antirheumatic drugs (DMARDs) are required to change the trajectory of RA. The typical pattern is persistent swelling and warmth in the wrists, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, often symmetrically. Morning stiffness commonly lasts longer than 30 to 60 minutes because inflamed synovium accumulates fluid and inflammatory mediators during inactivity. The distal interphalangeal joints are usually spared. Fatigue, reduced grip strength and difficulty with tasks such as opening containers may appear before the patient describes severe pain. RA is not confined to the joints. Assess for rheumatoid nodules, ocular inflammation or dryness, pleuritic symptoms,...