Artritis reumatoide

Abstract

Concept Rheumatoid arthritis is a systemic inflammatory disease of immune etiopathogenesis. Epidemiology Presence of persistent synovitis in the joints. The pattern of joint involvement is usually symmetrical and erosive and can develop at any age. Etiopathogenesis It is unknown, repeated exposure to certain environmental agents (tobacco and citrullination) has been related as a possible harmful mechanism, associated to a genetic predisposition to an immune response. Clinical manifestations Patients present swelling of the joints, and polyarticular clinical forms usually appear, with multiple clinical involvement and progress patterns. Other extra-articular manifestations can develop, such as skin diseases, rheumatoid nodules, or pleuropulmonary or hematological manifestations. Diagnosis It is conducted upon the presence of arthritis in association with radiographic and analytical data such as a positive rheumatoid factor and/or anti-citrullinated peptide antibodies. Treatment The course of the disease is poor if left untreated. Early treatment prevents structural progression. Some patients respond to traditional therapies with DMARDs (mostly methotrexate) and avoid further damage, but in many cases biological drugs are required, such as anti-TNF/anti-interleukin, or even anti-CD20, that have played an undisputed role in this disease.