RHEUMATOID ARTHRITIS: SYSTEMATIC REVIEW ON COMPLICATIONS, PROGNOSIS, AND TREATMENT

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, but can have a significant systemic impact on various organs and systems in the body. The complications associated with RA are wide-ranging and can be divided into joint and extra-articular complications. Joint complications include progressive destruction of cartilage, bone, and ligaments, leading to deformities, instability, and loss of function, with a higher incidence in the hands, feet, and larger joints such as the knees and hips. Extra-articular complications represent an additional significant risk for patients: there is an increased likelihood of cardiovascular events, lung diseases such as pulmonary fibrosis, as well as vasculitis, Sjögren's syndrome, frequent infections, and a greater predisposition to developing tumors. Other organs may also be affected, including the eyes and nervous system, amplifying the impact of the disease on overall health. The prognosis for RA varies and depends on several clinical and laboratory factors. The presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) is directly associated with a more aggressive form of the disease and, consequently, a worse prognosis. However, in recent years, early diagnosis and the implementation of appropriate treatment have contributed significantly to improving outcomes, reducing the progression of joint damage and disability, and increasing the life expectancy of patients. On the other hand, modifiable factors such as smoking, obesity, and poor treatment adherence can compromise prognosis and accelerate disease progression. The management of RA is multidisciplinary and combines pharmacological and non-pharmacological approaches. Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are used for symptomatic relief of pain and inflammation. Synthetic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine are the first line of treatment, aiming to control the disease and prevent irreversible joint damage. For patients who do not respond to these drugs, biological DMARDs (such as TNF and IL-6 inhibitors) and specific-target synthetic DMARDs (JAK inhibitors) are available, which act on different inflammatory pathways to control the disease. In the non-pharmacological approach, regular physical activity to improve flexibility, strength, and joint function, individualized physical therapy, the use of orthoses for joint protection, technical aids to increase independence in daily activities, and the importance of maintaining a balance between rest and activity, with attention to sleep quality, are highlighted.