Management of Rheumatoid Arthritis: An Overview

Abstract

Rheumatoid arthritis (RA) is a multifactorial autoimmune disease of unknown etiology, primarily affecting the joints, then extra-articular manifestations can occur. Due to its complexity, which is based on an incompletely elucidated pathophysiological mechanism, good RA management requires a multidisciplinary approach. The clinical status of RA patients has improved in recent years due to medical advances in diagnosis and treatment, that have made it possible to reduce disease activity and prevent systemic complications. The most promising results were obtained by developing disease-modifying anti-rheumatic drugs (DMARDs), the class to which conventional synthetic, biologic, and targeted synthetic drugs belong. Furthermore, ongoing drug development has led to obtaining molecules with improved efficacy and safety profiles, but further research is needed until RA turns into a curable pathology. In the present work, we offer a comprehensive perspective on the management of RA, by centralizing the existing data provided by significant literature, emphasizing the importance of an early and accurate diagnosis associated with optimal personalized treatment in order to achieve better outcomes for RA patients. In addition, this study suggests future research perspectives in the treatment of RA that could lead to higher efficacy and safety profiles and lower financial costs.

Mammalian Neuraminidases in Immune-Mediated Diseases: Mucins and Beyond

“…RA is an autoimmune disease of unknown etiology characterized by synovitis and bone erosion ( 349 ). A positive correlation between B cell surface ST3Gal-1/NEU3 ratio and RA disease severity was seen in patients with mild or high disease activity, but not patients in non-remission ( 342 ).…”

Biological and Methotrexate Survival after Pregnancy in Patients With a Rheumatic Disease

“…Rheumatic diseases are multifactorial autoimmune disorders with an unknown etiology, primarily affecting the joints. ( Smolen et al, 2016 ; Radu and Bungau, 2021 ). The treatment of rheumatic diseases has improved tremendously over the last decades, and now includes early initiation of disease-modifying anti-rheumatic drugs (DMARDs), a treat-to-target approach, and use of biologicals.…”

Polyphenols Targeting MAPK Mediated Oxidative Stress and Inflammation in Rheumatoid Arthritis

“…Several explanations have been proposed in the absence of a complete understanding of the pathophysiological mechanisms underlying RA. Immunological disorders have been shown to occur several years before the appearance of signs and symptoms, a period of time known as the pre-RA phase [5].…”

“…Following some processes of hypermutation and class-switch recombination, B cells begin to proliferate and differentiate into plasma cells that generate autoantibodies (RF, ACPA, etc. ), depending on the cellular precursors [5]. RF and ACPA are proteins produced by an immune system that has lost the ability to distinguish between self-and non-self-structures, so that in this case the tissues and organs can become targets by accident [7].…”

“…One of the best described mechanisms in the synovium is the cytokine release (IL-1, IL-6, TNF-α) from macrophages and plasma cells that can lead to the stimulation of osteoclast activity and production of matrix metalloproteinase (MMP), processes that can cause bone erosion and cartilage damage. Furthermore, neutrophils and immune complexes present in the synovial fluid are also responsible for cartilage and bone destruction by the action of MMP, complement system and reactive oxygen species (ROS) [5,8]. ROS were considered the main participant in this process [9].…”