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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 (1).
Epidemiology
Incidence
Annual incidence: United States is approximately 40 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% and 1%.
- Female:male 3:1; onset is typically between 30 and 50 years, but it can occur at any age.
- 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 cartilage and bone causing loss of cartilage and bony destruction with progressive joint deformity leading to significant disability.
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 by infection (e.g., Porphyromonas gingivalis) may provoke autoreactive T cells contributing to inflammation and joint-specific immune responses. Cigarette smoking and gingivitis 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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