Rheumatoid arthritis — master index¶
Last curated: 2026-11-01 · status: audited through 2026-08-31; 2026-10-11, 2026-10-18, 2026-10-25 and 2026-11-01 sweeps pending independent audit · 9 curated + 9 draft wiki pages · 309-paper live-retrieved master bibliography · 6 landmark-paper notes · 33-document guideline registry · 94-row statistics sheet plus 2026-10-11, 2026-10-18, 2026-10-25 and 2026-11-01 sweep tables · 9 verified patient-organization resources · 34 open questions + 8 unconnected-dots junctions
The condition in five sentences. Rheumatoid arthritis is a heterogeneous systemic autoimmune disease centered on persistent synovitis, with joint destruction and lung, vascular, bone, eye, nerve and infection consequences. GBD 2021 estimated 17.6 million people living with RA in 2020 and projects 31.7 million in 2050, while model and case-definition uncertainty remain substantial (GBD 2021 RA Collaborators 2023, PMID 37795020). ACPA/RF autoimmunity can predate swelling by years, and genetic susceptibility, smoking and mucosal biology shape risk without determining individual destiny (Dedmon 2020, PMID 32638005; Greenblatt 2020, PMID 32205569). Early methotrexate-centered treat-to-target care, followed when necessary by biologic or targeted therapy, prevents damage for many, but residual symptoms, difficult-to-treat disease, infection and JAK cardiovascular/cancer safety require mechanism- and risk-specific decisions (Grigor 2004, PMID 15262104; Ytterberg 2022, PMID 35081280). Prevention with abatacept, synovial-biopsy-guided selection and RA-ILD trials define the frontier, but none yet supplies a universal preventive, precision or lung-treatment algorithm (Rech 2024, PMID 38364841; Humby 2021, PMID 33485455; Saavedra 2025, PMID 39822854).
Start here: overview. Frontier: OPEN-QUESTIONS.md. Growth history: LOG.md.
Reading paths¶
- Clinical path — overview → classification and diagnosis → treat to target and remission → conventional DMARDs → biologic DMARDs → JAK inhibitors → guidelines
- Origins and mechanism path — preclinical autoimmunity → genetics, environment and mucosa → synovial immunobiology → biomarkers and tissue precision
- Safety and systemic path — extra-articular disease → RA-ILD → red flags
- Frontier path — open questions → clinical trials → biomarkers and tissue precision → difficult-to-treat RA
- Human and population path — epidemiology and burden → patient experience and advocacy → statistics → patient-voice themes
Pages¶
| Section | Page | Scope | Status |
|---|---|---|---|
| Foundations | overview.md | Autoimmunity, burden, treat-to-target care and frontier | curated |
| Foundations | classification-and-diagnosis.md | 2010 criteria, differential, serostatus and early arthritis | curated |
| Foundations | epidemiology-and-burden.md | Prevalence, incidence, disability, mortality and inequalities | curated |
| Origins | preclinical-autoimmunity-and-prevention.md | ACPA/RF phases, at-risk states and prevention trials | draft |
| Origins | genetics-environment-and-mucosal-origins.md | HLA, smoking, periodontium, lung and microbiome | curated |
| Mechanism | synovial-immunobiology.md | T/B cells, macrophages, fibroblasts, cytokines and erosion | curated |
| Clinical | treat-to-target-and-remission.md | Composite scores, remission, monitoring and tapering | draft |
| Clinical | conventional-dmards.md | Methotrexate, leflunomide, sulfasalazine and hydroxychloroquine | curated |
| Clinical | biologic-dmards.md | TNF, IL-6, B-cell and T-cell-costimulation therapies | draft |
| Clinical | jak-inhibitors-and-targeted-therapy.md | Efficacy, positioning, MACE/cancer/VTE signals | draft |
| Clinical | difficult-to-treat-and-refractory-ra.md | Definition, inflammation, pain, adherence and sequencing | draft |
| Systemic | extra-articular-and-comorbid-disease.md | Cardiovascular, infection, bone, eye, nerve and vasculitis | curated |
| Systemic | ra-associated-interstitial-lung-disease.md | Screening, phenotypes, prognosis and treatment | draft |
| Clinical | guidelines.md | EULAR, ACR and regional strategy differences | draft |
| Frontier | biomarkers-and-tissue-precision.md | Autoantibodies, omics, synovial biopsy and imaging | draft |
| Frontier | clinical-trials-landscape.md | Prevention, safety, biopsy and RA-ILD registrations | draft |
| Human | patient-experience-and-advocacy.md | Pain, fatigue, work, treatment burden and organizations | curated |
| Safety | red-flags-and-safety-concerns.md | Septic joint, cervical instability, lung decline and immunosuppression | curated |
Literature layer¶
| Artifact | Contents | Status |
|---|---|---|
| BIBLIOGRAPHY.md | 309 live-retrieved PubMed records with page provenance | 2026-10-11, 2026-10-18, 2026-10-25 and 2026-11-01 sweep additions pending audit |
| notes/ | Six deep notes: criteria, TICORA, ATTRACT, ORAL Surveillance, R4RA and ARIAA | audited |
| guidelines/REGISTRY.md | 33 current/historical documents, supersession chains, disagreements and watch list | 2026-10-11, 2026-10-18 and 2026-10-25 sweep additions pending audit; no 2026-11-01 document |
| statistics/STATISTICS.md | 94 method- and population-labelled rows plus 2026-10-11, 2026-10-18, 2026-10-25 and 2026-11-01 sweep tables | 2026-10-11, 2026-10-18, 2026-10-25 and 2026-11-01 sweep additions pending audit |
| patient-voice/README.md | Method and ethics | audited |
| patient-voice/organizations.md | Nine verified public organization resources | audited |
| patient-voice/themes.md | Eight cross-source themes | audited |
| patient-voice/sources.md | Annotated sources and coverage limits | 2026-10-25 source additions pending audit |
Curation state¶
This condition was audited on 2026-08-30 in the separate pass required by BUILD-PLAYBOOK.md. An independent audit of the 2026-08-31 literature sweep (auditor: Grok; author: Codex) re-fetched every newly added PMID and NCT and confirmed the two edited wiki pages. A 2026-10-11 literature sweep (author: Grok) added 13 PMIDs and 7 NCT identifiers; the eight edited wiki pages are draft pending a different-engine audit. A 2026-10-18 sweep (author: Claude) added 20 PMIDs (five of them catch-ups that predate the window, including the living Cochrane NMA after b/tsDMARD failure and the ERS/EULAR CTD-ILD guideline), 3 NCT identifiers and 2 ISRCTN identifiers; it edited seven pages that were already draft, so no page changed status. A 2026-10-25 sweep (author: Codex) added six bibliography records, one guideline document, two RA-ILD incidence rows and two public patient-source annotations. It sharpened OQ-3/4/5/7 and edited five wiki pages; the biomarkers page was demoted to draft, leaving nine curated and nine draft pages. A 2026-11-01 sweep (author: Grok) added eight bibliography records and two NCT identifiers, sharpened OQ-4/6, and edited three already-draft wiki pages. All sweep edits await a different-engine audit. The research corpus (wiki, literature Markdown and open questions; excluding historical logs and manifests) holds 312 unique PMIDs and 44 NCT identifiers. Registry UNKNOWN trial statuses are retained only where ClinicalTrials.gov currently returns that label.