Systemic complications of rheumatoid arthritis: Focus on pathogenesis and treatment

Preclinical data have suggested that nintedanib, an intracellular inhibitor of tyrosine kinases, inhibits processes involved in the progression of lung fibrosis. Although the efficacy of nintedanib has been shown in idiopathic pulmonary fibrosis, its efficacy across a broad range of fibrosing lung diseases is unknown.

RA is a chronic inflammatory disease resulting in severe morbidity and premature mortality. This review explores in a series of two articles, the current developments in the pathogenesis, diagnosis, monitoring and management of patients with RA. The diagnosis of early as well as established disease is discussed, including the diagnostic criteria. Particular emphasis is placed on the pitfalls and benefits of early diagnosis and early intervention. Prevention and limitation of comorbidity from the disease is highly important. This can be achieved following a paradigm shift in RA management. The emphasis is now on early introduction of disease-modifying anti-rheumatic drugs, including timely use of highly efficacious pharmacological innovations. Side effects, including peri-operative implications of pharmacological therapy, are discussed. Current therapeutic strategy to manage this disease should also be applied in resource-poor settings and developing countries. These therapies are cost effective if used early and judiciously, giving hope to many patients with RA.