Rheumatoid Arthritis
Summary
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterised by symmetrical inflammatory polyarthritis affecting small joints of hands and feet. Early diagnosis and treatment within the "window of opportunity" prevents joint destruction. Methotrexate is first-line DMARD; biologics (TNF inhibitors, IL-6 inhibitors, JAK inhibitors) are used for inadequate response.
Key Facts
- Definition: Chronic symmetric inflammatory polyarthritis
- Incidence: 0.5-1% prevalence
- Pathognomonic: Symmetrical small joint arthritis + RF/anti-CCP positive
- Gold Standard Investigation: Clinical + serology + imaging
- First-line Treatment: Methotrexate
- Prognosis: Good with early treatment; progressive if untreated
Clinical Pearls
Window Pearl: Treat early (within 3 months) - outcomes are much better.
Anti-CCP Pearl: More specific than RF; predicts erosive disease.
Extra-articular Pearl: Remember lung (ILD), heart, eyes, vasculitis.
- Joint involvement (score 0-5)
- Serology: RF, anti-CCP (score 0-3)
- Acute phase reactants (score 0-1)
- Duration greater than 6 weeks (score 0-1)
- Total 6 or more = definite RA
Algorithm
DMARDs
| Drug | Dose |
|---|---|
| Methotrexate | 15-25mg weekly (first-line) |
| Sulfasalazine | 2-3g daily |
| Hydroxychloroquine | 200-400mg daily |
Biologics
| Class | Examples |
|---|---|
| TNF inhibitors | Adalimumab, etanercept, infliximab |
| IL-6 inhibitors | Tocilizumab, sarilumab |
| JAK inhibitors | Tofacitinib, baricitinib |
| B-cell | Rituximab |
| T-cell | Abatacept |
-
Smolen JS et al. EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2020;79(6):685-699. PMID: 31969328
-
NICE guideline NG100. Rheumatoid arthritis in adults: management. 2018.
Viva Points
"RA: symmetrical small joint polyarthritis. RF/anti-CCP. Treat early with methotrexate. Biologics if inadequate response. Monitor with DAS28."
Last Reviewed: 2026-01-01 | MedVellum Editorial Team