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Many Management Strategies, No Cure

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by joint inflammation (synovitis) and the formation of rheumatoid pannus, leading to erosion of adjacent cartilage and bone and resulting in joint deformity, pain, severe disability, and premature death.1-5 Due to its systemic comorbidities, which include rheumatoid nodules, vasculitis, and pulmonary and cardiovascular involvement, RA is often defined as a syndrome.2-4 In 2005, an estimated 1.5 million (0.6%) adults in the United States were affected by RA, with women slightly more susceptible than men.2,6 An epidemiological study in 2005 estimated the lifetime risk of RA to be 4% for women and 2% for men.2,7 

The past decade has seen significant advances in the treatment of RA, along with recent updates to diagnosis and classification of the disease, with a focus on early recognition and treatment.1,4,8 Despite the significant strides, however, full remission in patients with RA, or continued remission after withdrawal of treatment, can be difficult to achieve.9 This article focuses on the application of conventional, new, and emerging treatment options for RA, and provides a review of current RA treatment recommendations and the challenges of current therapeutics.

Epidemiology and Etiology of RA

Although the etiology of RA is not yet completely understood, it is believed to result from a combination of environmental factors, susceptibility genes, epigenetic factors, and posttranslational modifications in individuals predisposed with a genetic susceptibility.4,5,10-12 A positive family history, considered the strongest risk factor for RA, increases the risk of RA more than 3 to 5 times.13 Studies have shown patterns of increased prevalence in specific ethnic populations, such as Pima Indians and Chippewa Indians, and in studies of migrant populations.11 The importance of genetic factors has further been demonstrated in studies with twins, where 50% to 60% of the occurrence of…

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