Advances in Management of Rheumatoid Arthritis: From Conventional Therapy to Targeted Treatment – A Narrative Review

Abstract

Context: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting approximately 0.5%–1% of the global population. It is characterized by persistent synovial inflammation, predominantly involving the small joints in a symmetrical pattern, progressive joint destruction, and substantial functional disability. The pathogenesis of RA involves genetic predisposition, environmental triggers, and immune dysregulation, leading to the activation of T cells, B cells, and proinflammatory cytokines, including TNF-α, IL-1, and IL-6. Evidence Acquisition: Advances in understanding the mechanisms of RA have led to substantial improvements in management strategies. Results: Current treatment approaches emphasize prompt diagnosis, early initiation of disease-modifying antirheumatic drugs (DMARDs), and a treat-to-target strategy aimed at achieving remission or low disease activity. Conventional DMARDs, particularly methotrexate, remain the cornerstone of therapy, whereas biologic agents and targeted synthetic DMARDs, such as JAK inhibitors, provide options for refractory disease. Nonpharmacological interventions and lifestyle modifications may further improve outcomes. Despite substantial therapeutic progress, delayed diagnosis, limited access to advanced therapies, and high treatment costs continue to impede optimal disease management, particularly in resource-limited settings. Conclusions: This narrative review summarizes current treatment strategies, recent therapeutic advances, and key healthcare barriers relevant to improving rheumatoid arthritis outcomes globally and in developing-country contexts. It emphasizes conventional disease-modifying therapies, biologic and targeted synthetic agents, and treat-to-target approaches; highlights major challenges in resource-limited settings, particularly Pakistan; and discusses evolving strategies to improve long-term patient outcomes.