Rheumatoid arthritis (RA) is a common autoimmune disease, presenting with symmetrical, destructive and deforming polyarthritis affecting small and large peripheral joints with associated systemic disturbance. The exact aetiology is elusive and multifactorial with genetic, infectious, environmental and hormonal factors all apparently involved. Recently, new techniques of PCR and metagenomics (gene sequencing) have revealed significant microbial involvement in this condition, with antigens from viruses, bacteria and superantigens, all found in the synovial fluid of RA patients.
Symptom severity and disease progression vary widely between individuals. Onset may be rapid or insidious.
Approximately 20% of cases experience periods of partial to complete remission. Flare-ups may involve more joints than were initially affected, but remission periods often last longer than flare-ups. The majority of cases however are progressive, and the rate of progression can be slow or rapid. Early age of onset, high rheumatoid factor titre and elevated erythrocyte sedimentation rate correspond to a poor prognosis. Involvement of more than 20 to 30 joints and presence of extra-articular symptoms also correspond with a poor outcome. Women generally have a poorer outcome than men. Individuals experiencing unrelieved symptoms for two or more years are at increased risk of premature death due to infection, heart disease, respiratory failure, renal failure, and gastrointes tinal disease.

Risk factors:
Major causative factors and risk factors that can contribute to the incidence of RA include:
• Genetic predisposition
• Gender – RA strikes women in a 3:1 ratio to men
• Age – most commonly presents at 40 to 60 years, although RA occurs at all ages
• Smoking – increases or accelerates the risk in susceptible people
• Environmental toxicity – due to leaky gut, heavy me tal toxicity.
• Chronic or latent infections – recognised trigger and driver of auto-immunity

Signs and Symptoms:
Common signs and symptoms of RA include:
• Malaise, low-grade fever and weight loss
• Stiffness in and about joints following inactivity
• Morning stiffness lasts for more than one hour in active disease
• Arthritis of more than three joints – specifically proximal interphalangeal, metacarpophalangeal, wrist, elbow, knee, ankle, and metatarsophalangeal joints
• Joint stiffness, tenderness, and pain; the affected joints are swollen and may be warm to the touch
• Extra-articular symptoms such as rheumatoid nodules , pleural effusion, pericarditis, lymphadenopathy, splenomegaly with leukopenia, vasculitis, anaemia, etc
• Finger deformities include Boutonniere deformity, swan-neck deformity and ulnar deviation.
• Synovitis with pannus formation (i.e., thickening of synovium)
• Cartilage breakdown and/or bone erosion