Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic joint inflammation. The condition is significantly more common in women than men. Common signs and symptoms include joint pain, tenderness, redness, increased warmth, swelling, stiffness, and, if left untreated, joint deformity. RA typically affects both larger and smaller joints, where constant inflammation can result in significant damage to cartilage and nearby bones, tendons, blood vessels, and eventually joint destruction. In some cases, extra-articular manifestations may occur, meaning that other organs besides the joints are affected.

In recent decades, the treatment of RA has become more aggressive, contributing to better preserved function and milder joint damage in patients. Despite these advancements, treatment options have not always met the needs of RA patients for effective and safe treatment, with issues such as inadequate efficacy, tolerance difficulties, and increased susceptibility to infections remaining in many cases.

The latest treatment guidelines from the European League Against Rheumatism (EULAR, 2022) recommend treatment with conventional synthetic Disease Modifying Anti-Rheumatic Drugs (csDMARDs) such as methotrexate (MTX) for moderate to high activity RA. Additionally, corticosteroids (steroids) may be used initially and intermittently under exacerbations, usually in oral formulations. In cases of poorer prognosis or inadequate efficacy, treatment is often supplemented with a biological DMARD (bDMARD) that blocks proinflammatory signaling proteins such as tumor necrosis factor-alpha (TNF-α), or another csDMARD.. At a later stage, treatment with targeted synthetic DMARDs (tsDMARDs) such as Janus Kinase (JAK) inhibitors may be considered. Similar treatment strategies are also used in the treatment of other rheumatic diseases.