Introduction:
     Subhamoy Maity is studying Final BHMS at Kharagpur Homoeopathic Medical College, Kharagpur, Midnapur,West Bengal. He had contributed many articles for publication. His interest in study and understanding the medical science with a great curiosity in dynamism has been expressed here as an article.

Rheumatoid Arthritis
     Rheumatoid Arthritis is a chronic, progressive systemic inflammatory disorder that primarily targets the joints of middle-aged adults. Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50.The inflammatory process originates in and emanates from joints over taken by a proliferating synovial membrane. It manifests as a symmetric arthritis involving numerous small and large joints.

Cause
     The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. Some scientists believe that the tendency to develop rheumatoid arthritis may be genetically inherited. It is suspected that certain infections or factors in the environment might trigger the immune system to attack the body’s own tissues, resulting in inflammation of various organs of the body such as the lungs or eyes.

     Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation in the joints and occasionally other tissues of the body. Immune cells, called lymphocytes, are activated and chemical messengers (cytokines, such as tumor necrosis factor/TNF and interleukin-1/IL-1) are expressed in the inflamed areas.

     Environmental factors also seem to play some role in causing rheumatoid arthritis. Recently, scientists have reported that smoking, tobacco chewing increases the risk of developing rheumatoid arthritis. Autoimmunity is held responsible for this disease.

Clinical features
     The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment, and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and patients generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies from patient to patient, and periods of flares and remissions are typical.

     When the disease is active, symptoms can include fatigue, loss of appetite, low grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

     In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected). The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars can become difficult during flares. The small joints of the feet are also commonly involved. Occasionally, only one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection. Chronic inflammation can cause damage to body tissues, cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function.

Diagnosis
     The distribution of joint inflammation is important to the doctor in making a diagnosis. In rheumatoid arthritis, the small joints of the hands, wrists, feet, and knees are typically inflamed in a symmetrical distribution. When only one or two joints are inflamed, the diagnosis of rheumatoid arthritis becomes more difficult. The doctor may then perform other tests to exclude arthritis due to infection or gout.

Investigations
     Abnormal blood antibodies can be found in patients with rheumatoid arthritis. A blood antibody called “rheumatoid factor” can be found in 80% of patients. An antibody called the “antinuclear antibody” (ANA) is also frequently found in patients with rheumatoid arthritis.

     ESR rate is usually faster during disease flares, and slower during remissions. Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein. Joint x-rays may be normal or only show swelling of soft tissues early in the disease. As the disease progresses x-rays can show bony erosions typical of rheumatoid arthritis in the joints. Joint x-rays can also be helpful in monitoring the progression of disease and joint damage over time.

Treatment and Management
     The treatment for Rheumatoid Arthritis is a challenge to the medical fraternity. Homoeopathy can serve best of all. Even though there are lot of drugs like Bryonia, Rhustox, Ledum pal, Causticum , Guaiacum,Colchicum ,Kali Mur gives relief, an antimiasmatic remedy is needed for complete cure.