Long-Standing Untreated or Inadequately Treated Seropositive Rheumatoid Arthritis in the Golden Age of Disease-Modifying Antirheumatic Drugs

Rheumatoid arthritis (RA) is a chronic inflammatory disease presenting with articular and extra-articular manifestations that could be related to genetic and environmental factors. Seropositive RA is marked by the presence of autoantibodies, which are associated with worse prognoses and increased risk of extra-articular manifestations, including cardiovascular diseases, lung disorders, and malignancies. Untreated RA can lead to substantial morbidity, reduced life expectancy, and poor quality of life. The development of disease-modifying antirheumatic drugs has paved the way for improving disease outcomes and reducing morbidity and complications related to disease. However, adherence to therapy remains a challenge, often influenced by drug intolerance, misconceptions, and negative beliefs regarding potential side effects and drug toxicity. Here, we report three cases presenting with devastating complications due to long-standing untreated or inadequately treated seropositive RA. This emphasizes the huge disease burden and poor quality of life as part of the natural course and progression of untreated RA. Comprehensive patient education on the disease course, treatment benefits, and potential side effects is essential to enhance adherence and facilitate shared decision-making.