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Review
. 2023 Nov 25;402(10416):2019-2033.
doi: 10.1016/S0140-6736(23)01525-8. Epub 2023 Oct 27.

Rheumatoid arthritis

Andrea Di Matteo  1 , Joan M Bathon  2 , Paul Emery  3
Affiliations
Review

Rheumatoid arthritis

Andrea Di Matteo et al. Lancet. .

Abstract

Rheumatoid arthritis is a chronic, systemic, autoimmune inflammatory disease that mainly affects the joints and periarticular soft tissues. In this Seminar, we provide an overview of the main aspects of rheumatoid arthritis. Epidemiology and advances in the understanding of rheumatoid arthritis pathogenesis will be reviewed. We will discuss the clinical manifestations of rheumatoid arthritis, classification criteria, and the value of imaging in the diagnosis of the disease. The advent of new medications and the accumulated scientific evidence demand continuous updating regarding the diagnosis and management, including therapy, of rheumatoid arthritis. An increasing number of patients are now able to reach disease remission. This major improvement in the outcome of patients with rheumatoid arthritis has been determined by a combination of different factors (eg, early diagnosis, window of opportunity, treat-to-target strategy, advent of targeted disease-modifying antirheumatic drugs, and combination therapy). We will discuss the updated recommendations of the two most influential societies for rheumatology worldwide (ie, the American College of Rheumatology and European Alliance of Associations for Rheumatology) for the management of rheumatoid arthritis. Furthermore, controversies (ie, the role of glucocorticoids in the management of rheumatoid arthritis and safety profile of Janus kinase inhibitors) and outstanding research questions, including precision medicine approach, prevention, and cure of rheumatoid arthritis will be highlighted.

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Conflict of interest statement

Declaration of interests PE has received grants from Lilly and Samsung; consulting fees from BMS, Boehringer-Ingelheim, Lilly, and Novartis; payment and honoraria from Galapagos, Lilly, and Novartis; support for attending meetings or travel from Lilly; and has participated on a data safety monitoring board or advisory board with AstraZeneca. All other authors declare no competing interests.

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