Fact-sheet: Rheumatoid arthritis
Updated on 09/28/2026 at 12:16 PM
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Definition
Systemic autoimmune and inflammatory disease, polyarticular, destructive, characterized by synovial involvement and possible extra-osseous manifestations (notably rheumatoid lung).
The most common inflammatory rheumatism in adults, generally around age 50, with a female predominance.
Clinical features
Morning stiffness Joint pain ++ Joint swelling ++ Subcutaneous rheumatoid nodules +/-
Laboratory findings
Very often: elevated anti-CCP; sometimes RF+ (not specific in isolation).
Anti-citrullinated protein antibodies (ACPA), often positive but not specific for RA (their absence does not rule out the diagnosis)
Radiography
Joint space narrowing Bone erosions Soft tissue swelling Initially periarticular osteoporosis Deformities Ankylosis No periosteal reaction, enthesopathy, or calcification Generally symmetric involvement, typically sparing the DIP joints In the spine: atlantoaxial subluxation, pseudo-basilar impression, erosions, inflammatory discitis
Management
- Prompt rheumatology referral for pre-therapeutic work-up Symptomatic treatments: analgesics, NSAIDs, coxibs, corticosteroid therapy.
- Conventional disease-modifying treatments: Methotrexate as first-line therapy Leflunomide, sulfasalazine, cyclosporine, and other immunosuppressants.
- Biologic therapies: Anti-TNF alpha, abatacept, rituximab, tocilizumab, anakinra.
Differential diagnosis
Erosive form of digital osteoarthritis Psoriatic arthritis Gout Spondyloarthropathy of dialysis patients Sarcoidosis, connective tissue diseases