Published date: Dec 29 2023

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 18 (2023), Issue No. 4

Pages: 539–551

DOI: 10.18502/sjms.v18i4.14742

Kanwal Ashiqpharmacist.kanwal6@gmail.comUniversity College of Pharmacy, University of the Punjab Lahore, Pakistan

Sana AshiqCenter for Applied Molecular Biology (CAMB), University of the Punjab Lahore, Pakistan

Aisha MobasharFaculty of Pharmacy, University of Lahore, Lahore, Pakistan

Farah AbidFaculty of Pharmacy, Khaldunia Institute of Technology and Applied Sciences (KITAAS), Lahore, Pakistan

Anam YasmeenUniversity College of Pharmacy, University of the Punjab Lahore, Pakistan

Naureen ShehzadiUniversity College of Pharmacy, University of the Punjab Lahore, Pakistan

Muhammad Tanveer KhanFaculty of Pharmacy, Lahore College for Women University (LCWU), Pakistan

Khalid HussainFaculty of Pharmacy, University of Lahore, Lahore, Pakistan

Rheumatoid arthritis (RA) is a systemic self-inflicted inflammatory disease that primarily affects middle-aged women. Globally, 1% of people live with RA. This review aims to provide updated information on the different aspects of RA, including its epidemiology, pathophysiology, diagnosis, treatment, and management. A web-based literature search was conducted through various databases, including PubMed, Google Scholar, and Science Direct, to identify the most relevant studies. Epidemiological studies have suggested that the prevalence and occurrence of RA have remained inconsistent across geographical areas in different periods. Many factors such as age, gender, inheritances, and environmental exposure can contribute to the severity of the disease. The acute form of RA usually presents with pain, and if left untreated, it can result in joint deformities and influence a patient’s quality of life (QoL). RA diagnosis is usually based on the manifestation of pain with inflammation. Currently, many therapeutic strategies are available for the cure of RA. The management of daily routine activities is required with treatment to curtail the damage, avoid future deformities, and ultimately minimize the aching trouble of the patient.

Keywords: arthritis, inflammation, joints, quality of life, autoimmunity

[1] Rahimizadeh, P., Rezaieyazdi, Z., Behzadi, F., Hajizade, A., & Lim, S. I. (2021). Nanotechnology as a promising platform for rheumatoid arthritis management: Diagnosis, treatment, and treatment monitoring. International Journal of Pharmaceutics, 609, 121137. https://doi.org/10.1016/j.ijpharm.2021.121137

[2] Aletaha, D., & Smolen, J. S. (2018). Diagnosis and management of rheumatoid arthritis: A review. Journal of the American Medical Association, 320(13), 1360–1372. https://doi.org/10.1001/jama.2018.13103

[3] Shakil, M., Saleem, D. M., Zafar, A., Ali, A., Raziq, M., & Shams, S. (2021). Clinical and hematological parameters in patients of Rheumatoid arthritis in a tertiary care hospital. Rawal Medical Journal, 46(1), 45–45.

[4] Khaliq, T., Khan, A., & Malik, I. A. (2020). Clinical profile and treatment outcomes of patients with rheumatoid arthritis at a tertiary care hospital of Pakistan. JPMA. The Journal of the Pakistan Medical Association, 70, 1143–1149. https://doi.org/10.5455/JPMA.289952

[5] Mittinty, M. M., Elliott, J. M., Hunter, D. J., Nicholas, M. K., March, L. M., & Mittinty, M. N. (2022). Explaining the gap in the experience of depression among arthritis patients. Clinical Rheumatology, 41(4), 1227–1233. https://doi.org/10.1007/s10067-021-06010-0

[6] Ashiq, K., Rehman, K., Ashiq, S., & Ahlam, S. (2017). Influence of osteoporosis on quality of life and current strategies for its management and treatment. GSC Biological and Pharmaceutical Sciences, 1(2), 34– 40.https://doi.org/10.30574/gscbps.2017.1.2.0051

[7] Yerima, A., Akintayo, R., & Adebajo, A. (2021). Implications of a diagnosis of rheumatoid arthritis in resource-poor countries. Best Practice & Research Clinical Rheumatology. https://doi.org/10.1016/j.berh.2021.101725

[8] Clayton, S. A., MacDonald, L., Kurowska-Stolarska, M., & Clark, A. R. (2021). Mitochondria as key players in the pathogenesis and treatment of rheumatoid arthritis. Frontiers in Immunology, 12, 1488. https://doi.org/10.3389/fimmu.2021.673916

[9] McInnes, I. B., & Schett, G. (2017). Pathogenetic insights from the treatment of rheumatoid arthritis. Lancet, 389(10086), 2328–2337. https://doi.org/10.1016/S0140- 6736(17)31472-1

[10] Mueller, A. L., Payandeh, Z., Mohammadkhani, N., Mubarak, S. M. H., Zakeri, A., Alagheband Bahrami, A., Brockmueller, A., & Shakibaei, M. (2021). Recent advances in understanding the pathogenesis of rheumatoid arthritis: New treatment strategies. Cells, 10(11), 3017. https://doi.org/10.3390/cells10113017

[11] Tobón, G. J., Youinou, P., & Saraux, A. (2010). The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis. Autoimmunity Reviews, 9(5), A288– A292. https://doi.org/10.1016/j.autrev.2009.11.019

[12] Otón, T., & Carmona, L. (2019). The epidemiology of established rheumatoid arthritis. Best Practice & Research. Clinical Rheumatology, 33(5), 101477. https://doi.org/10.1016/j.berh.2019.101477

[13] Podgórska, D., Cieśla, M., Kolarz, B. (2022). FCER1G gene hypomethylation in patients with rheumatoid arthritis. Journal of Clinical Medicine, 11(16), 4664.

[14] Fang, Q., Ou, J., & Nandakumar, K. S. (2019). Autoantibodies as diagnostic markers and mediator of joint inflammation in arthritis. Mediators of Inflammation, 2019, 6363086. Advance online publication. https://doi.org/10.1155/2019/6363086

[15] Harre, U., Lang, S. C., Pfeifle, R., Rombouts, Y., Frühbeißer, S., Amara, K., Bang, H., Lux, A., Koeleman, C. A., Baum, W., Dietel, K., Gröhn, F., Malmström, V., Klareskog, L., Krönke, G., Kocijan, R., Nimmerjahn, F., Toes, R. E., Herrmann, M., . . . Schett, G. (2015). Glycosylation of immunoglobulin G determines osteoclast differentiation and bone loss. Nature Communications, 6(1), 6651. https://doi.org/10.1038/ncomms7651

[16] Burmester, G. R., Feist, E., & Dörner, T. (2014). Emerging cell and cytokine targets in rheumatoid arthritis. Nature Reviews Rheumatology, 10(2), 77–88. https://doi.org/10.1038/nrrheum.2013.168

[17] McInnes, I. B., Buckley, C. D., & Isaacs, J. D. (2016). Cytokines in rheumatoid arthritis – Shaping the immunological landscape. Nature Reviews Rheumatology, 12(1), 63–68. https://doi.org/10.1038/nrrheum.2015.171

[18] Fang, Q., Zhou, C., & Nandakumar, K. S. (2020). Molecular and cellular pathways contributing to joint damage in rheumatoid arthritis. Mediators of Inflammation, 2020, 3830212. Advance online publication. https://doi.org/10.1155/2020/3830212

[19] Tuna, H. I., Alparslan, G. B., & Yilmaz, S. (2022). Pain and affected symptoms of patients with rheumatoid arthritis during COVID-19 period. Pain Management Nursing, 23(1), 43–47. https://doi.org/10.1016/j.pmn.2021.08.004

[20] Chancay, M. G., Guendsechadze, S. N., & Blanco, I. (2019). Types of pain and their psychosocial impact in women with rheumatoid arthritis. Women’s Midlife Health, 5(1), 3. https://doi.org/10.1186/s40695-019-0047-4

[21] Kaptoge, S., Di Angelantonio, E., Pennells, L., Wood, A. M., White, I. R., Gao, P., Walker, M., Thompson, A., Sarwar, N., Caslake, M., Butterworth, A. S., Amouyel, P., Assmann, G., Bakker, S. J., Barr, E. L., Barrett-Connor, E., Benjamin, E. J., Björkelund, C., Brenner, H., . . . Danesh, J., & the Emerging Risk Factors Collaboration. (2012). C-reactive protein, fibrinogen, and cardiovascular disease prediction. The New England Journal of Medicine, 367(14), 1310–1320. https://doi.org/10.1056/NEJMoa1107477

[22] Kaushik, P., Solomon, D. H., Greenberg, J. D., Anderson, J. T., Reed, G., Pala, O., Sumbul-Yuksel, B., Kadam, P., Kremer, J. M., & the CORRONA investigators. (2015). Subcutaneous nodules are associated with cardiovascular events in patients with rheumatoid arthritis: Results from a large US registry. Clinical Rheumatology, 34(10), 1697–1704. https://doi.org/10.1007/s10067-015-3032-9

[23] Lin, Y. J., Anzaghe, M., & Schülke, S. (2020). Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells, 9(4), 880. https://doi.org/10.3390/cells9040880

[24] do Prado, A. D., Staub, H. L., Bisi, M. C., da Silveira, I. G., Mendonça, J. A., Polido- Pereira, J., & Fonseca, J. E. (2018). Ultrasound and its clinical use in rheumatoid arthritis: Where do we stand? Advances in Rheumatology (London, England), 58, 19. Advance online publication. https://doi.org/10.1186/s42358-018-0023-y

[25] Takase-Minegishi, K., Horita, N., Kobayashi, K., Yoshimi, R., Kirino, Y., Ohno, S., Kaneko, T., Nakajima, H., Wakefield, R. J., & Emery, P. (2018). Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: Systematic review and meta-analysis. Rheumatology (Oxford, England), 57(1), 49–58. https://doi.org/10.1093/rheumatology/kex036

[26] Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., III, Birnbaum, N. S., Burmester, G. R., Bykerk, V. P., Cohen, M. D., Combe, B., Costenbader, K. H., Dougados, M., Emery, P., Ferraccioli, G., Hazes, J. M., Hobbs, K., Huizinga, T. W., Kavanaugh, A., . . . Hawker, G. (2010). 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis and Rheumatism, 62(9), 2569– 2581. https://doi.org/10.1002/art.27584

[27] Akram, M., Daniyal, M., Sultana, S., Owais, A., Akhtar, N., Zahid, R., Said, F., Bouyahya, A., Ponomarev, E., Ali Shariat, M., & Thiruvengadam, M. (2021). Traditional and modern management strategies for rheumatoid arthritis. Clinica Chimica Acta, 512, 142–155. https://doi.org/10.1016/j.cca.2020.11.003

[28] Ruffer, N., Krusche, M., Beil, F. T., Amling, M., Kötter, I., & Rolvien, T. (2022). Clinical features of methotrexate osteopathy in rheumatic musculoskeletal disease: A systematic review. Seminars in Arthritis and Rheumatism, 52, 151952. https://doi.org/10.1016/j.semarthrit.2022.151952

[29] Paglia, M. D. G., Silva, M. T., Lopes, L. C., Barberato-Filho, S., Mazzei, L. G., Abe, F. C., & de Cássia Bergamaschi, C. (2021). Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis. PLoS One, 16(4), e0248866. https://doi.org/10.1371/journal.pone.0248866

[30] Hua, C., Buttgereit, F., & Combe, B. (2020). Glucocorticoids in rheumatoid arthritis: Current status and future studies. RMD Open, 6(1), e000536. https://doi.org/10.1136/rmdopen-2017-000536

[31] Ashiq, K., Bajwa, M. A., Khokhar, R., Abid, F., Tanveer, S., Qayyum, M., Ashiq, S., & Jameel, S. (2022). A Cross-sectional analysis of knowledge, beliefs and practices regarding traditional medicine use among pharmacy students of different private and government universities of Lahore, Pakistan. Bangladesh Journal of Medical Science, 21(2), 323–334. https://doi.org/10.3329/bjms.v21i2.58065

[32] Chaudhary, A., & Vinay, P. (2020). Rheumatoid arthritis: Etiology, treatment and animal models. Journal of Drug Delivery and Therapeutics, 10(no. 5-s), 290–298. https://doi.org/10.22270/jddt.v10i5-s.4357

[33] Sarsenova, M., Issabekova, A., Abisheva, S., Rutskaya-Moroshan, K., Ogay, V., & Saparov, A. (2021). Mesenchymal stem cell-based therapy for rheumatoid arthritis. International Journal of Molecular Sciences, 22(21), 11592. https://doi.org/10.3390/ijms222111592

[34] Ashiq, K., Bajwa, M. A., Tanveer, S., Qayyum, M., Ashiq, S., Khokhar, R., & Abid, F. (2021). A comprehensive review on gout: The epidemiological trends, pathophysiology, clinical presentation, diagnosis and treatment. JPMA. The Journal of the Pakistan Medical Association, 71(4), 1234–1238. https://doi.org/10.47391/JPMA.313

[35] Babar, Z. U. D. (2022). Forming a medicines pricing policy for low and middleincome countries (LMICs): The case for Pakistan. Journal of Pharmaceutical Policy and Practice, 15(1), 9. https://doi.org/10.1186/s40545-022-00413-3