Rheumatoid arthritis (RA) is an autoimmune, chronic, progressive, disabling, inflammatory condition of synovial joints which follows a remitting and relapsing course. RA is more common in women than men and usually occurs between the ages 40-50, although it can affect at any age. Patient with RA may report increase in pain and stiffness in the morning that can last about thirty minutes to an hour and is often accompanied by swelling of some of the joints. The onset of RA will vary from person to person and may be rapid or occur over a period of time (Chamberlain, 2014). .
RA is an autoimmune disease that affects the population worldwide. The etiology of RA is complex and uncertain, with both genetic and environmental factor that influence the predisposition (Madsen, 2011). It had been suggested that the disease is initiated in a genetically predisposed individual by the activation of a T-cell-mediated response to an immunologic trigger, such as a microbial agent. Smoking cigarette is also a strong non genetic risk factor for the development of RA and may influence the severity of the disease especially in those with the shared epitope (Porth, 2015). Also, an accelerated development of atherosclerosis had been observed in patients with rheumatic disease (Madsen, 2011).
The pathogenesis of rheumatoid arthritis can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joints architecture. The activation of the CD4+ helper T cells had been suggested that the disease is initiated by this. It has been estimated that 70% to 80% of person with this disease has a substance called rheumatoid factors. A rheumatoid factor is an antibody that reacts with a fragment of immunoglobulin G (IgG) to form immune complexes. Even though a patient with RA may not have Ig RF in their serum (seronegative), the presence of a high RF titer is frequently associated with sever and unremitting disease, mainly systemic complication (Porth, 2015).