The presentation of RA typically involves symmetric joint pain, stiffness, and swelling, most commonly affecting the hands, wrists, and feet. The stiffness is often worse in the morning or after periods of inactivity, lasting for more than thirty minutes. RA can also cause more generalized symptoms, such as fatigue, fever, and weight loss. As the disease progresses, it can lead to joint damage and loss of function, affecting the quality of life.

The evaluation of a patient suspected of having RA includes a thorough clinical history and physical examination, focusing on joint symptoms, duration of stiffness, and the presence of any extra-articular manifestations. Laboratory tests are crucial in the diagnosis and management of RA. Common tests include rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are present in many but not all RA patients. Other important tests include the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which help assess the inflammatory activity. Imaging studies, such as X-rays, ultrasound, or MRI, can detect joint damage and inflammation and help monitor disease progression.

Treatment of RA aims to manage symptoms, reduce inflammation, prevent joint and organ damage, and improve overall function. This involves a combination of medication, lifestyle modifications, and sometimes surgery. Medications used in the treatment of RA include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents.

DMARDs, such as methotrexate, sulfasalazine, and leflunomide (Arava), are often the first-line treatment and can slow the disease’s progression. Biologic therapies represent a significant advancement in treating RA. These drugs target specific components of the immune system involved in the inflammatory process. Biologics used in RA treatment include tumor necrosis factor (TNF) inhibitors (e.g., etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi, Simponi Aria)), interleukin-6 (IL-6) receptor inhibitors (e.g., tocilizumab (Actemra)), Janus kinase (JAK) inhibitors (e.g., tofacitinib (Xeljanz), baricitinib, upadacitinib (Rinvoq)), and other agents targeting different pathways, such as abatacept (Orencia), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), apremilast (Otezla), a bsarilumab (Kevzara), and risankizumab (Skyrizi).

The choice of treatment depends on several factors, including disease severity, patient preferences, potential side effects, and other health conditions. Close monitoring by a rheumatologist is essential to manage the disease effectively and adjust treatment as needed.