Rheumatoid arthritis
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Inflammation and Regeneration
REVIEW
Open Access
Rheumatoid arthritis Yoshiya Tanaka
Abstract Rheumatoid arthritis is an autoimmune inflammatory disease primarily characterized by synovitis which is accompanied by extra-articular organ involvement, such as interstitial pneumonia, in addition to clinical symptoms including pain, swelling, stiffness of multiple joints, fever, and malaise. Joint destruction progresses soon after the onset, and once the affected joints are deformed, the development of irreversible physical dysfunction is noted. Thus, proper diagnosis and treatment are required from the early stages of the disease. Although palliative therapy with glucocorticoids and antiinflammatory drugs had been used, disease-modifying antirheumatic drugs (DMARDs) are currently used to suppress immune abnormalities and to control disease activity. DMARDs are classified into different groups, such as conventional synthetic DMARD, targeted synthetic DMARD, and biologic DMARD. The appropriate use of these drugs has allowed remission to be the therapeutic goal in all patients. By maintaining remission, these drugs have also been shown to prevent the progression of joint destruction and physical dysfunction over a long period. The advent of molecular-targeted therapies has allowed for the use of treatments based on pathological mechanisms, and such therapeutic strategies have also been applied to the treatment of various autoimmune inflammatory diseases. In the future, safer and more effective treatments, therapeutic strategies aimed at drug holidays or cure, and the introduction of precision medicine are expected. Keywords: Rheumatoid arthritis, Diagnosis, Treatment, DMARD, Biological
Backgrounds Rheumatoid arthritis is an autoimmune inflammatory disease primarily characterized by synovitis. It commonly affects women in their 30s to 50s, with an incidence of 1 in 150. It is accompanied by multi-organ disorders, in addition to pain, swelling, and stiffness of multiple joints. Joint destruction progresses rapidly after onset, resulting in irreversible physical dysfunction and deformation of the affected joints. Thus, proper diagnosis and treatment are required in the early stages of the disease. The term rheumatism comes from the 2500-year-old Greek word meaning “flowing current,” indicating the flow of the affected joints in the entire body. This disease has afflicted humanity for a long period of time, and its treatment also has a long history. There is a 2500-year-old record stating that drinking a decoction of European white willow bark alleviates pain. In the Correspondence: [email protected] The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan
nineteenth century, salicin was discovered as a component of the bark. In 1853, Gerhardt first synthesized acetylsalicylic acid, which had superior in vivo stability to salicin, and in 1897, acetylsalicylic acid was marketed as a tablet for arthralgia by Hoffmann in Baye
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