Mini review paper about Rheumatoid Arthritis.

1. Rheumatoid Arthritis: Risk factors and potential treatments
José Eduardo Ramos Miranda
University of Puerto Rico at Cayey, Cayey, Puerto Rico, Department of Natural Sciences
Abstract:
This paper reviews the disease of rheumatoid arthritis(RA) and how finding its causes are so
important for the prevention of this autoimmune disease. Throughout the years this disease has
been in our lives, affecting mainly the adult population, and narrowing it down to female patients.
Specifically, we can see how different institutes of health try to determine possible diagnoses and
causes for this disease. Treatment and rehabilitation are important for the control of this disease.
RA is a chronic disease, meaning its effects keep increasing over time. But luckily we have
treatments that slow down this process and makes coping with RA easier. Methrotexate (MTX) is
highlighted throughout this paper because of the amount of people who are using it recently. At
the end, suggested research that is being worked on is presented to enlighten the conscience of
these patients
Table of Contents:
Introduction
Origin of rheumatoid arthritis and autoimmune diseases
Diagnosis
Rheumatoid Arthritis description
Risks factors of rheumatoid arthritis
Potential remedies or reatments
Metrotexate
Conclusion
Introduction
Rheumatoid arthritis (RA) is a complex disease affecting approximately 0.5% of the adult
population worldwide, and it occurs in 20-50 cases per 100,000 annually. It strikes mainly women
in their 40s or older (Carmona et al. 2010). Its origin remains elusive, but there is evidence that
both genetic and environmental factors trigger the pathogenesis. Growing evidence suggests that
RA consists of at least 2 different subsets characterized by the presence or absence of antibodies to
citrullinated protein antigen (ACPA) (Svendsen et al. 2013). RA is located in all areas of the world
in which the prevalence rates for females tend to be higher than the rate for males. Medline Plus
(2014), states that this specific form of arthritis causes pain, swelling, stiffness, and loss of
function in your joints such as wrist and fingers. RA is an autoimmune disease that mistakenly
attacks healthy cells in your body. In addition, there is no proven cause of why autoimmune
diseases appear. The author states that there are more than 80 types of autoimmune diseases, and
some are very similar, nevertheless the main goal in treating these diseases is to reduce the
inflammation. Anyone can get this disease even though there is no proven cause. Gaujoux et al.
(2014) say that this disease runs a chronic course marked by flares of synovial membrane
inflammation that can eventually cause joint destruction, thereby compromising quality of life and
causing disability.

2. Sometimes we can ask ourselves, how is it diagnosed? Well even though this disease can be hard
to diagnose because its symptoms take time to really develop. Common diagnoses include:
medical history, physical exams, x rays, and lab tests. Carmona et al. (2010) describes the
emphasis is now on early intervention with the aim of preventing disability and irreversible
damage, resulting in a race to find the earliest point in time to treat the disease safety. RA has
different name varieties in which it is diagnosed: early RA, undifferentiated RA, and advanced
RA. We can deduce that even because RA is very present in our everyday lives and it is virtually
impossible to fight; there is still an option to keep finding a plausible cause or solution to this
overwhelming disease.
Risks factors of RA
When it comes to relevant risks factors for the occurrence of the condition, Carmona et al. (2010)
states many factors in the pathogenesis of this disease. First, RA involves multiple genes, but
genes with the major histo-compatability complex appear to have the strongest influence on the
susceptibility of the disease. The major histo-compatability complex is a group of genes that code
for proteins that are situated in the surface of the cells. Also, this complex works with the immune
system, targeting foreign substances. Even though the concept of susceptibility factors is still
being researched, we can assume that factors like this one certainly have a huge effect on what is
going on with this disease. Secondly, Carmona et al. (2010) reports that a significantly increased
risk of RA has been demonstrated in women whose pregnancies were complicated by hypermesis,
gestational hypertension, or pre-clampsia. Hypermesis is a disorder that causes the pregnant
woman to suffer from nausea, vomiting, weight loss and even electrolyte deduction. Meanwhile,
pre-clampsia is another disorder that affects the blood pressure of the patient and the high
concentration of protein in the urine. The author gives certain sex-related associations that go in
relation with the mother having a higher susceptibility than the man. This is very alarming because
this segment of the population is the most delicate, due to the dangers related to the different
stages of child birth. The third factor that the authors mention is general lifestyle factors. Habits
like smoking are etiological factors because they show a clear interaction with genetic
susceptibility genes. Infections also play a part on this disease; Epstein-Barr virus, parvovirus, and
bacteria like Proteus and Mycoplasma. These factors are very important because they can serve as
warning signs to patients who have symptoms or are suffering from this disease. Carmona et al.
(2010) suggests that future patients should take into consideration: behavioral factors, climate,
environmental exposures, RA diagnosis and genetic factors.
Potential Remedies or Treatments
The optimal management of patients with RA requires a dialogue between the rheumatologist and
patient to ensure that the patient receives the information and education needed to share in his or
her management decisions (Gaujoux et al. 2014). Thanks to advances in science we can say that
RA can be treated, even though this is a chronic disease. The main goals are to: take away pain,
reduce swelling, slow down or stop joint damage, help people feel better, and stay active. These
main goals are given by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Treatments can and may involve lifestyle changes, medicine, surgery, regular doctor visits and
alternative therapies. One main factor that affects the variation between treatments is the state of
the patient. Some people may have an advanced type of disease while other patients may still be in

3. the early stages. This makes it necessary have a diverse array of options when it comes to the
quantity or type of treatment for RA, or in any type of autoimmune disease. Gaujoux et al. (2014)
proposes a three-phase treatment plan: this algorithm starts with Phase I, and the treatment
strategies for recent-onset of RA. After the diagnosos of RA there is an initiation of MTX,
combined with short-term glucocorticoid therapy, plus an initiation of sulfasalazine or
leflunomide. After a waiting period or three to six months we can determine to continue the
treatment or go to Phase II. The second phase consists on treatment strategies for RA with an
inadequate response to methotrexate, starting off by using add-on biologic (anti-TNF or abatacept
or tocilizumab or rituximab), and if there is failure switch to other DMAR LEF, SSZ, MTX alone
or combined. After the stipulated waiting period you can continue the treatment or go to the final
phase. The final and third phase is a treatment strategy in RA with an inadequate response to
biologic therapy. The patient has the option to switch to a second anti-TNF or abatacept or
tocilizumab or rituximab in case that the treatment doesn’t seem effective. The method is very
useful when helping patients with very different needs when it comes to treatments.
Methrotrexate
The use of immunosuppressive agents in the treatment of rheumatoid arthritis began in the 1950s
after the introduction of NSAIDs and corticosteroids (Cripriani et al. 2014). Later, other drugs that
are from the same ladder, were introduced and formed a very important part in this line of
treatment for the patient. Among the disease-modifying antirheumatic drugs, MTX
(methrotrexate) is currently considered the “anchor drug” for the treatment of RA; it is
administered in up to 70% of patients with this disease (Cipriani et al. 2014). This is an alarming
and essential detail. The rheumatologist is the specialist who should be in charge of managing
patients with RA (Gaujoux et al. 2014). For over 50 years this antimetabolite drug has established
itself as effective to many autoimmune disorders that have been developed over the years.
Cripriani et al. (2014) studied available research in relation to (MTX) and how it is useful for RA
patients. They pointed to the importance of MTX and the routes of oral, subcutaneous, and
intramuscular administration. The importance of the oral MTX route was highlighted throughout
the study. However, the main reason parenteral (injected) administration of this drug is
recommended is because of the patient’s poor compliance with taking the oral dosage. The authors
provided good and helpful information on whether to consider the oral administration of MTX, or
parenteral administration, keeping in mind that both are beneficial to the quality of life of the
patient with RA. Secondly, the dosage and quantity of MTX was also considered a factor in terms
of the direct effect of the drug. Cipriani et al (2014) informs us that MTX acts specifically during
the synthesis of RNA and DNA in the S phase of the cell cycle. Also, the author reports that many
studies have pointed out to the long-term efficacy and safety of MTX. This drug is a great choice
for the first-line of treatment for a recent onset of RA, and as a consequence, it improves the
overall response of the patient’s disease.
Conclusion
There is a suggestion that the incidence and severity of RA may have declined over the past few
decades. This decline has been attributed to the trend to ‘invert the pyramid and to diagnose and
treat rheumatoid disease earlier and more aggressively (Carmona et al. 2010). The author also
mentions that the pattern of use of treatments, with earlier aggressive treatment and the
introduction of new drug therapies, is a more than plausible cause for the new found decline. The

4. aggressiveness factor from this article may have a point when it comes to an overall projection on
what is the immediate future for RA. When it comes to treatments, the use of MTX is highly
recommended because of so many testimonies of active patients taking the drug. Cipriani et al.
(2014) suggest that OR-MTX should be initiated at the highest tolerable dose, with a progressive
weekly increase of the drug to the maximal recommended dosage and an early witch to the
parental route in case of unresponsiveness or evidence of adverse effects, before switching to
another drug. We may not have a clear idea of the exact causes of this disease, but at least we have
advances on different treatments that can slow down this chronic and devastating illness.
Nevertheless we must have in consideration that by knowing more of these high risk factors, we
can introduce at a much higher lever drugs and natural remedies that stop the disease effects.
Further research is being done now in many areas like: immune systems, genes, families with
rheumatoid arthritis, new drugs or drug combinations, rheumatoid arthritis and disability,
preventing related health problems, and quality of life for people with rheumatoid arthritis. All of
these routes are being explored for the sake of our physical well-being.
Cited Literature:
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Arthritis: Optimizing Therapy Among Different Formulations. Current and Emerging
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Institute of Health; [2014 January 7; 2014 October 31]. Available at:
http://www.nlm.nih.gov/medlineplus/rheumatoidarthritis.html
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Institute of Health; [2014 August 9; 2014 October 31]. Available at:
http://www.nlm.nih.gov/medlineplus/autoimmunediseases.html
6. National Institute of Arthritis and Musculoskeletal and Skin Diseases
[Internet].[2009].Bethesda, (MD): U.S. Department of Health and Human Services Public
Health Service; [2014 October 31]. Available at:
http://niams.nih.gov/Health_Info/Rheumatic_Disease/rheumatoid_arthritis_ff.pdf
7. Svendsen A, Kyvik K, Houen G, Junker P, Christensen K, Christiansen L, Nielsen C, Skytthe
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