Abstract / Summary
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder traditionally characterized by persistent synovitis, progressive cartilage destruction, bone erosion, pain, stiffness, functional impairment, and disability. Contemporary understanding, however, has moved beyond the concept of RA as a disease confined to synovial joints. The disease represents a complex interaction among genetic susceptibility, environmental exposures, mucosal immune activation, autoantibody formation, dysregulated innate and adaptive immunity, chronic cytokine signalling, and progressive structural damage. Extra-articular manifestations involving the lungs, cardiovascular system, skin, eyes, nervous system and other organs contribute substantially to morbidity and mortality. Recent evidence has also emphasized the possible contribution of smoking, periodontal inflammation, microbiome alterations and post-translational protein modifications such as citrullination to disease initiation and progression. Early recognition and timely disease-modifying antirheumatic drug (DMARD) therapy remain central to contemporary RA management. Treat-to-target strategies, shared decision-making, monitoring of disease activity, management of comorbidities, rehabilitation, lifestyle modification and prevention of treatment-related complications form important components of comprehensive care. Current American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) recommendations emphasize early DMARD initiation and individualized therapeutic escalation according to disease activity, prognostic factors, safety and patient preferences. Homoeopathy has historically been used by some patients with chronic rheumatic disorders, including RA. Limited clinical studies have investigated individualized homoeopathic treatment, including a randomized controlled trial involving patients with established RA. A recent systematic review identified a small number of RA studies within the broader rheumatological literature but also highlighted the limited size and methodological heterogeneity of the available evidence. Consequently, homoeopathy should presently be considered an area requiring rigorous clinical investigation rather than an evidence-equivalent substitute for established disease-modifying treatment. This narrative review examines RA from its immunopathogenesis to systemic manifestations, contemporary clinical management, and the potential role and research requirements of individualized homoeopathic therapeutics.