Rheumatoid Arthritis: Multifactorial Pathway

Abstract: Rheumatoid Arthritis or RA is commonly known as autoimmune disease associated with joint destruction. RA is a chronic systemic autoimmune disease characterized by persistent inflammation of the synovial joints, leading to pain, swelling, stiffness and progressive joint destruction. It primarily affects peripheral joints in a symmetrical pattern, with small joints of the hands and feet being most commonly involved. The pathogenesis of RA involves a complex interplay between genetic susceptibility, environmental triggers (such as smoking), and immune dysregulation. Key immunological mechanisms include activation of T cells, B cells, and macrophages, leading to the production of auto antibodies like rheumatoid factor (RF) and anti- citrullinated protein antibodies, along with pro-inflammatory cytokines such as TNF-α, IL-6 and IL-17. Diagnosis relies on clinical assessment, serological markers and imaging modalities. Approximately 0.5-1% of world population is suffering from RA among which industrialized countries are at high risk. The disease adversely affects every day work of people suffering and decreases their quality of life. The course of treatment is based on balancing the immune response but still only temporary relief is provided from disease. 20% of Indian population is suffering from disease and increasing the load on healthcare systems. The review is to understand various pathological pathways involved in the progression of RA and risk factors that influence susceptibility of an individual to suffer from RA.