In this episode, we explore rheumatoid arthritis (RA), a chronic systemic autoimmune disease that primarily targets synovial joints and leads to progressive inflammation, cartilage destruction, and bone erosion. We review the underlying pathophysiology, including the formation of the inflammatory pannus and the role of immune-mediated cytokine activity that drives joint damage. The episode highlights key clinical features such as morning stiffness lasting more than 30 minutes, symmetric polyarthritis of the small joints of the hands and feet, and extra-articular manifestations affecting the eyes, lungs, and cardiovascular system. We also discuss the 2010 ACR/EULAR diagnostic criteria, important laboratory markers like rheumatoid factor and anti-CCP antibodies, and imaging findings. Finally, we emphasize the critical 3–6 month "window of opportunity" for early treatment with disease-modifying antirheumatic drugs—especially methotrexate—to prevent irreversible joint damage and long-term disability.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018;320(13):1360–1372. doi:10.1001/jama.2018.13103
3. Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet. 2023 Nov 25;402(10416):2019-2033. doi: 10.1016/S0140-6736(23)01525-8. Epub 2023 Oct 27. PMID: 38240831.
4. Peterson E, Gallagher MK, Wilbur J. Rheumatoid Arthritis: Diagnosis and Management for the Family Physician. Am Fam Physician. 2024 Nov;110(5):515-526. PMID: 39556634.
5. Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/