Understanding the Rheumatoid Process
The rheumatoid process is a chronic autoimmune inflammatory disease where the immune system attacks synovial joints, causing progressive joint destruction, and it is called "rheumatoid" from the Greek word "rheuma" meaning "flowing" or "flux," historically referring to the belief that disease-causing humors flowed through the body to settle in the joints. 1
What is the Rheumatoid Process?
Core Pathophysiology
Rheumatoid arthritis is the most common autoimmune disease affecting the joints, characterized by the immune system mistakenly targeting the body's own tissues, particularly the synovial lining of joints. 1
The disease involves both innate and adaptive immune mechanisms that closely interplay to promote chronic joint inflammation. 2
The autoimmune response targets post-translationally modified proteins, particularly citrullinated proteins, which are neither tissue nor organ-specific but comprise a broad collection of modified autoantigens. 2
T and B cells become activated in the earliest phases of disease, with RA appearing as a Th1 and Th17-mediated disease. 3
Inflammatory cytokines play a considerable role in the hierarchy of processes involved in RA, driving the inflammatory cascade. 3
Clinical Manifestations
The hallmark clinical features include symmetric polyarthritis with joint swelling, especially affecting the hands and feet, though any appendicular joint may become involved. 1
Patients experience morning stiffness lasting 1 hour or longer, which is a typical sign related to disease activity. 1, 4
The disease causes progressive synovial joint damage through inflammation, leading to joint instability, deformity, and limited range of motion. 5
Extra-articular manifestations include subcutaneous nodules, interstitial lung disease, vasculitis, and inflammatory eye disease, which are markers of severe disease. 1
Disease Impact
Life expectancy is shortened by 3 to 5 years, especially in patients with extra-articular disease and those developing serious treatment-related adverse effects. 1
More than one-third of patients eventually experience work disability, with employment rates declining from 80% at 2 years to 68% at 5 years after disease onset. 1
The disease significantly reduces quality of life if left untreated, though it usually does not directly cause death. 6
Etymology: Why "Rheumatoid"?
Historical Context
The term "rheumatoid" derives from the Greek word "rheuma" (ῥεῦμα), meaning "flowing," "flux," or "stream," reflecting ancient medical theories about disease causation.
Historical medical understanding attributed diseases to imbalances of bodily humors that would "flow" through the body and accumulate in specific locations, causing symptoms.
When these disease-causing humors were believed to settle in the joints, they produced the inflammatory arthritis we now understand as rheumatoid arthritis.
The suffix "-oid" means "resembling" or "like," so "rheumatoid" literally means "resembling the flowing disease" or "like rheumatism."
Modern Understanding vs. Historical Naming
While the name reflects outdated humoral theory, it has persisted in modern medicine despite our current understanding of autoimmune pathophysiology. 3
The disease is now understood as an autoimmune process involving complex interactions between genetic susceptibility (e.g., HLA-DRB1), environmental factors (e.g., smoking), and immune dysregulation, not flowing humors. 7
The autoimmune component involves production of rheumatoid factor and anti-citrullinated peptide antibodies (ACPA) against common autoantigens. 3