Literature Review - Rheumatoid Arthritis

Running Head : LITERATURE REVIEW
Literature Review
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Summary
Rheumatoid arthritis is one chronic disease that is affecting up to 1% of people in the
developed countries. There are certain environmental and genetic factors which appeared to
promote the development of rheumatoid arthritis but the affected patients can present symptom
related to heterogeneous. The goals of any treatment of rheumatoid arthritis are to decrease the
inflammation and the remission of disease. As far as history is concerned, the treatment used to
be with Aspirin and the colloidal gold which were inadequate and could not affect the entire
course of the Rheumatoid arthritis. In the recent practices, there are the synthetic diseases
modifying anti-rheumatic drugs which are biological also helpful in reducing severity of the
disease. Since, Rheumatoid arthritis is a long-term condition; the pharmacist can work in
collaboration with the providers for ensuring that there is proper dosage of drug, titration and
monitoring.
Overview
The rheumatoid arthritis is one inflammatory and auto-immune disease which can cause
swelling, pain, stiffness and loss of function in different joints such as raised knees and hands.
The lining of the joint becomes inflamed which can lead to tissue damage along with chronic
pain deformity and unsteadiness. There is a bilateral pattern of disease progression such as both
knees are affected or both hands. That can be effecting the extra particular sites such as the lungs
mouth and heart (Arthritis.org. 2020).. The patients can experience a different type of acute
worsening of the condition which is disease flare but with the early e recognition and appropriate
treatment of the disease the symptoms can become ameliorated for a particular duration that is
also called disease remission.
The epidemiology

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In the year 2005, the rheumatoid arthritis was prevalent among 1.3 million adults in the
reports of United States and within two years it affected 1.5 million adult. The latest data on
rheumatoid arthritis in the USA are not available but it can be assumed that the rates are high.
Rheumatoid arthritis can also occur in many ethnic groups and. Notably, women are found to be
undergoing a two-three times greater impacts for development of RA as compared to men
(Cdc.gov. 2020).. The rheumatoid arthritis usually occurs in the people of middle age and more
common in the older adults but it is surprisingly found to be developing in the children and the
young adults also.
The pathogenesis of rheumatoid arthritis
The reason of Rheumatoid arthritis stays unknown but there can be some insights into the
pathogenic ways that has accumulated over the past years. There is a plethora of cells which
entered the synovium through activated endothelial cells having expressed different additional
molecules. There are different cell types specifically the dendritic cells that express the pattern
identification molecules as Toll-like receptors which can bind two different foreign and the self
structure being part of the innate immune activity. This become subsequently activated and then
act on the cells of the immune system that is adaptive. There are antigens which are connected
with the Arthritis and present it to the T cells through professional antigen presenting cells or the
APC as dendritic cells, the B cells or the macrophages (Geuskens, Burdorf & Hazes, 2020).. This
particular process consists of the binding of antigenic peptides to the class II MHC molecule
because more than 85% of patients having rheumatoid arthritis carry the shared epitope of the
HLA-DRB1*04 cluster. Notably, in the rheumatoid arthritis, the Synovial membrane there are
some other cell population which accumulate through activated endothelial cells. Apart from
traditional self population of the adaptive and innate immune system, the position of new

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vascularisation is there having large development in the fibroblast like synoviocytes that are
activated highly for producing cytokines the inflammatory mediators as Matrix
metalloproteinases and prostaglandins. With the secretion of metalloproteinases into the
Synovial fluid, the fibroblast shaped synoviocites can easily destroy the cartilages and assist in
the bone destruction. However, there are erosion of the bones tissues which can happen through
activation of the osteoclasts because of the bone reserving machinery such as Cathepsin K.
Notably, the osteoclasts are derived from the macrophages and the monocytes which
differentiate between the Synovial membrane. There are many cytokines which are activated in
the synovium through different cell populations and few of them are secreted by the macrophage
cells. These include the TNF and the Interleukin 1 constituting the therapeutic targets of various
compounds for the RA being licensed over the previous years. This can directly inhibit the
inflammatory mediators. There are other proinflammatory cytokines that can be induced through
TNF and Interleukin 1 which has always been the focus of many researchers. Significantly, the
cytokines could have different significant activities in the primary context of pathogenesis of the
Rheumatoid arthritis which induces the production of antibody by the B cells activating the T
cells, the osteoclasts and the macrophages. This is a major activator among the hepatic responses
of acute phase.
The etiology
As far as the causes of RA are concerned, it is unknown but the environmental factors,
the genes along with the hormones can be involved in the auto-immune development and its
progression. There are factors which appear to develop the risk of older age with higher
coincidence in the 60 above people, the gender having the higher incidence in women. the
genetics specifically the class history of the life, smoking of tobacco, cigarettes, obesity, the