Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease with multi-organ involvement. It primarily affects peripheral joints symmetrically. While its pathophysiology is largely understood, its etiology remains unknown. Cytokines such as tumor necrosis factor (TNF) and interleukin (IL)-6 play a crucial role in the pathogenesis and perpetuation of inflammation in RA. The natural progression of RA leads to joint deformity and disability, as well as a reduced life expectancy due to increased cardiovascular risk, pulmonary involvement, infections, iatrogenic causes, or tumors. Chronic non-cancer pain, joint deformity, and fatigue are the cardinal symptoms of RA. Early diagnosis and access to targeted therapies aimed at early remission have improved the prognosis of rheumatoid arthritis (RA). The latest generation of treatments, known as DMARDs (dsDMARDs), are expensive and practically inaccessible to RA patients. Therefore, alternative treatments for RA must be considered when DMARDs prove refractory for these patients. Materials and methods: This systematic review consists of a literature analysis on RA, with the main objective of identifying conventional and alternative treatments within the context of the disease. Searches were conducted in the following online databases: Cochrane Library, Google Scholar, and SciELO. Results: A total of 296 articles were obtained that refer to the subject of study and its definitions. Conclusion: To publicize and encompass all existing treatment options for patients diagnosed with RA, promoting access to comprehensive literature resulting from thorough research that contributes to improving the quality of life of these patients. Keywords: “Rheumatoid arthritis [MeSH]”, “pathophysiology [MeSH]”, “symptoms [MeSH]”, “treatment [MeSH]”, “cost analysis [MeSH]”, “adjuvants in symptomatic relief in patients with RA [MeSH]”
References
1. Scublinsky D. Recomendaciones de la Sociedad Argentina de Reumatología para el tratamiento de la artritis reumatoidea. Revista Argentina de Reumatología 2025;36:01–01. https://doi.org/10.47196/rar.v36i1.914.
2. Robbins y Cotran - Patologia Estructural y Funcional 9a Edición n.d.
3. Alwarith J, Kahleova H, Rembert E, Yonas W, Dort S, Calcagno M, et al. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr 2019;6. https://doi.org/10.3389/fnut.2019.00141.
4. Almeida C, Choy EH, Hewlett S, Kirwan JR, Cramp F, Chalder T, et al. Biologic interventions for fatigue in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2016;2016. https://doi.org/10.1002/14651858.cd008334.pub2.
5. Hajkhan AM, Nieves AT. Tratamiento de la artritis reumatoide n.d.
6. Díaz-González F, Hernández-Hernández MV. Artritis reumatoide. Medicina Clínica 2023;161:533–42. https://doi.org/10.1016/j.medcli.2023.07.014.
7. Paladino MJM. LA EVALUACIÓN ECONÓMICA DE MEDICAMENTOS Y LA FARMACOECONOMÍA n.d.
8. Dávila NOF. Analgésicos coadyuvantes para el tratamiento del dolor crónico 2010.
9. Martínez AB, Muñoz L de A. Abordaje del dolor crónico no oncológico n.d.
10. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. The Lancet 2016;388:2023–38. https://doi.org/10.1016/S0140-6736(16)30173-8.
11. 5133-D-2020.pdf n.d.
12. Protocolo de Recupero: Artritis Reumatoidea. Argentina.gob.ar 2019. https://www.argentina.gob.ar/noticias/protocolo-de-recupero-artritis-reumatoidea (accessed August 5, 2025).
13. Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. The Lancet 2011;377:2226–35. https://doi.org/10.1016/S0140-6736(11)60402-9.
14. Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases 2020;79:685–99. https://doi.org/10.1136/annrheumdis-2019-216655.
15. Álvaro-Gracia Álvaro JM, Díaz Del Campo Fontecha P, Andréu Sánchez JL, Balsa Criado A, Cáliz Cáliz R, Castrejón Fernández I, et al. Actualización del Documento de Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas y sintéticas dirigidas en la artritis reumatoide. Reumatología Clínica 2024;20:423–39. https://doi.org/10.1016/j.reuma.2024.05.007.
16. Orozco VHA, Burgos García M, Girón LN, Pacheco R, Orozco VHA, Burgos García M, et al. Terapia biológica en artritis reumatoidea: una revisión de reacciones adversas. Revista Colombiana de Reumatología 2022;29:239–48. https://doi.org/10.1016/j.rcreu.2021.03.014.
17. Sanmartí R, Tornero J, Narváez J, Muñoz A, Garmendia E, Ortiz AM, et al. Eficacia y seguridad de los glucocorticoides en la artritis reumatoide: revisión sistemática de la literatura. Reumatol Clin 2020;16:222–8. https://doi.org/10.1016/j.reuma.2018.06.007.
18. Scublinsky D. Recomendaciones de la Sociedad Argentina de Reumatología para el tratamiento de la artritis reumatoidea. Revista Argentina de Reumatología 2025;36:01–01. https://doi.org/10.47196/rar.v36i1.914.
19. Schneeberger EE, Asnal CA, Babini A, Berbotto G, Cazenave T, Citera G, et al. CAPÍTULO 2: Manejo terapéutico en pacientes con artritis reumatoidea. Rev Argent Reumatol 2025;36:08–22. https://doi.org/10.47196/rar.v36iSup1.927.
20. Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases 2020;79:685–99. https://doi.org/10.1136/annrheumdis-2019-216655.
21. Alcántara Montero A, Ibor Vidal PJ, Alonso Verdugo A, Trillo Calvo E. Actualización en el tratamiento farmacológico del dolor neuropático. Medicina de Familia SEMERGEN 2019;45:535–45. https://doi.org/10.1016/j.semerg.2019.05.008.
22. Chaparro LE, Wiffen PJ, Moore RA, Gilron I. Combination pharmacotherapy for the treatment of neuropathic pain in adults. Cochrane Database of Systematic Reviews 2012;2020. https://doi.org/10.1002/14651858.CD008943.pub2.
23. Welsch P, Üçeyler N, Klose P, Walitt B, Häuser W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia - Welsch, P - 2018 | Cochrane Library n.d.
24. Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132:237–51. https://doi.org/10.1016/j.pain.2007.08.033.
25. Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med 2004;21:114–21. https://doi.org/10.1111/j.1464-5491.2004.01109.x.
26. Häuser W, Petzke F, Sommer C. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome. J Pain 2010;11:505–21. https://doi.org/10.1016/j.jpain.2010.01.002.
27. Whittle SL, Richards BL, Husni E, Buchbinder R. Opioid therapy for treating rheumatoid arthritis pain. Cochrane Database Syst Rev 2011:CD003113. https://doi.org/10.1002/14651858.CD003113.pub3.
28. Scalabrino G. The multi-faceted basis of vitamin B12 (cobalamin) neurotrophism in adult central nervous system: Lessons learned from its deficiency. Prog Neurobiol 2009;88:203–20. https://doi.org/10.1016/j.pneurobio.2009.04.004.
29. Deutz NEP, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 2014;33:929–36. https://doi.org/10.1016/j.clnu.2014.04.007.
30. Uso racional de coxibs. Rev Esp Reumatol 2000;27:398–400.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Pedro Sebastián Rodriguez, Fátima Bergalli (Author)