Rheumatoid Arthritis


Rheumatoid arthritis is a common inflammatory disorder primarily affecting synovial joints but also other organs. It is characterized by immune‐driven chronic inflammation, relapses and remissions. It is strongly associated with the presence of rheumatoid factor in the blood and has a significant genetic predisposition, notably from certain immune response genes. Dramatic advances in therapies mean that progressive disability may no longer be inevitable.

Keywords: aetiology; immunogenetics; treatment; epidemiology; management

Figure 1.

Cumulative involvement of joints in rheumatoid arthritis.

Figure 2.

Typical rheumatoid joint deformities in the hands. There is wasting of the small muscles of the hand, swelling of the metacarpophalangeal joints and a small subcutaneous nodule on the little finger. The fingernail ‘clubbing’ is characteristic of the pulmonary fibrosis from which this patient also suffered.

Figure 3.

Plain radiograph (left) and magnetic resonance image (right) of the cervical spine in rheumatoid arthritis, revealing subaxial subluxation and spinal cord compression.


Further Reading

Arnett FC, Edworthy SM, Bloch DA et al. (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheumatism 31: 315–324.

Begovich AB, Carlton VE, Honigberg LA et al. (2004) A missense single‐nucleotide polymorphism in a gene encoding a protein tyrosine phosphatase (PTPN22) is associated with rheumatoid arthritis. American Journal of Human Genetics 75: 330–337.

Choi HK, Hernan MA, Seeger JD, Robins JM and Wolfe F (2002) Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359: 1173–1177.

Dunbar RP and Alexiades MM (1998) Decision making in rheumatoid arthritis: determining surgical priorities. Rheumatic Disease Clinics of North America 2: 35–54.

Firestein GS, Panayi GS and Wollheim FA (2000) Rheumatoid Arthritis: New Frontiers in Pathogenesis and Treatment. Oxford: Oxford University Press.

Van Gaalen FA, Linn‐Rasker SP, van Venrooij WJ et al. (2004) Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: a prospective cohort study. Arthritis and Rheumatism 50: 709–715.

Jawaheer D, Seldin MF, Amos CI et al. (2003) Screening the genome for rheumatoid arthritis susceptibility genes: a replication study and combined analysis of 512 multicase families. Arthritis and Rheumatism 48: 906–916.

Kirwan J (1995) The effect of glucocorticoids on joint destruction in rheumatoid arthritis. New England Journal of Medicine 333: 142–146.

Klareskog L, van der HD, de Jager JP et al. (2004) Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double‐blind randomised controlled trial. Lancet 363: 675–681.

Kroot EJ, de Jong BA, van Leeuwen MA et al. (2000) The prognostic value of anti‐cyclic citrullinated peptide antibody in patients with recent‐onset rheumatoid arthritis. Arthritis and Rheumatism 43: 1831–1835.

Maini R, St Clair EW and Breedveld F et al. for the ATTRACT Study Group (1999) Infliximab (chimeric anti‐tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet 354: 1932–1939.

Pinals RS, Masi AT and Larsen RA (1981) Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis and Rheumatism 24: 1308–1315.

Weinblatt ME, Keystone EC, Furst DE et al. (2003) Adalimumab, a fully human anti‐tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis and Rheumatism 48: 35–45.

Weinblatt ME, Kramer JM, Bankhurst AD et al. (1999) A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. New England Journal of Medicine 340: 253–259.

Wordsworth BP, Bell JI (1998) Specific immune responses. In: Isenberg DA, Maddison PJ, Isenberg D et al. (eds) The Oxford Textbook of Rheumatology, 3rd edn, pp. 424–432. Oxford: Oxford University Press

Wordsworth BP, Lanchbury JSS, Sakkas LI et al. (1989) HLA‐DR4 subtype frequency in RA indicates that DRB1 is the major susceptibility locus within the human leukocyte antigen class II region. Proceedings of the National Academy of Sciences of the USA 86: 10049–10053.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Wordsworth, Paul, and Holden, Wendy(Jan 2006) Rheumatoid Arthritis. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1038/npg.els.0004113]