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Rheumatoid arthritis--a review
1Department of Rheumatology and Immunology, Tan Tock Seng Hospital, Singapore.
Annals of the Academy of Medicine, Singapore
|May 20, 1998
Summary
Rheumatoid arthritis (RA) is an inflammatory condition influenced by genetics and environment. Early treatment with slow-acting drugs can limit joint damage and disease progression.
Area of Science:
- Immunology
- Rheumatology
- Genetics
Background:
- Rheumatoid arthritis (RA) is a common chronic inflammatory arthritis.
- Its etiology is unknown, likely involving genetic and environmental interactions.
- Strongest genetic link is to HLA-DR4, but MHC genes account for <50% of susceptibility.
Purpose of the Study:
- To review the pathogenesis, diagnosis, and management of rheumatoid arthritis.
- To highlight the role of early intervention in disease modification.
Main Methods:
- Review of existing literature on rheumatoid arthritis pathogenesis and treatment.
- Analysis of clinical observations regarding disease course in community versus hospital patients.
Main Results:
- RA may follow a milder course in community patients compared to hospital patients.
- Early pathogenesis involves T-cell mediation, shifting to T-cell independent mechanisms later.
- Fibroblast-like synoviocytes contribute to joint destruction in later stages.
Conclusions:
- Diagnosis is primarily clinical.
- Management focuses on controlling synovitis to prevent joint damage.
- Early use of slow-acting anti-rheumatic drugs is recommended to limit disease progression.
- Biological therapies represent a promising future treatment avenue.