Arthritis, Rheumatoid (RA)
BASICS
DESCRIPTION
Rheumatoid arthritis (RA) is a symmetric inflammatory disease primarily causing synovial inflammation and leading to the destruction of bone and cartilage.
EPIDEMIOLOGY
Incidence
Annual incidence: The United States is approximately 70 per 100,000 persons.
Prevalence
- Prevalence: 0.5–1% of the general population worldwide; in the United States, the prevalence is the same as globally, between 0.5–1%.
- Female:male, 3:1
- The lifetime risk of developing RA: 3.6% in women and 1.7% in men.
ETIOLOGY AND PATHOPHYSIOLOGY
RA is a chronic inflammatory disease caused by an unchecked synovial proliferation. A pannus forms and erodes into the cartilage and bone causing loss of cartilage and bony destruction with progressive joint deformity leading to significant disability. Macrophage and osteoclast activation by multiple cytokines (tumor necrosis factor [TNF]-α, interleukin [IL]-1, and IL-6) contributes to the disease process.
Genetics
RA has strong familial associations; a parent with RA increases the risk by 3-fold over standard incidence, a sibling by 4.6, and a parent and sibling with RA increases the risk by 9.3. HLA-DRB1 linked to a higher risk of RA.
RISK FACTORS
Disruption of the gut microbiome may provoke autoreactive T cells contributing to inflammation and joint-specific immune responses. Cigarette smoking and gingivitis can also exacerbate the inflammatory process.
GENERAL PREVENTION
Smoking cessation, a well-balanced diet, achieving a healthy weight, regular physical activity, regular dental checkups, and good dental hygiene; diet rich in omega-3 fatty acids.
COMMONLY ASSOCIATED CONDITIONS
Fatigue, sleep disturbances, depression, fibromyalgia, osteoporosis, atherosclerotic coronary artery disease, lung disease (pleuritis, pleural effusion, interstitial fibrosis and pulmonary nodules), episcleritis, scleritis, Sjögren disease.
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