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State-of-the-art: rheumatoid arthritis
  1. Iain B McInnes1,
  2. James R O'Dell2
  1. 1Institute of Infection, Immunity and Inflammation, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
  2. 2Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Iain B McInnes, Institute of Infection, Immunity and Inflammation, Glasgow Biomedical Research Centre, University of Glasgow, 120 University Place, Glasgow G12 8QQ, UK; iain.mcinnes{at}


The understanding of the pathogenesis and optimal therapeutics for rheumatoid arthritis (RA) has advanced remarkably over the last decade. This review highlights these key advances, particularly the outcomes of genome-wide scans which have provided an increasingly robust appraisal of the complex genetics that underpin RA. Such observations are placed in pathogenetic context, particularly concerning the breach of tolerance that presages synovitis and the mechanisms that subserve chronicity. The key therapeutic strategies and treatment agents, both conventional and biological, now available to effectively manage the disease are described. Throughout the review, emphasis is placed on unanswered questions and challenges in this exciting field.

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  • See Editorial, p 1895

  • Funding NIH, Wellcome Trust, MRC (UK) and Arthritis Research UK.

  • Competing interests IMcI has received grants or honoraria from Roche, Pfizer, Schering Plough and BMS who manufacture biologic agents used in the treatment of rheumatoid arthritis.

  • Provenance and peer review Commissioned; externally peer reviewed.

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  • Miscellaneous
    BMJ Publishing Group Ltd and European League Against Rheumatism