Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that primarily affects the synovial joints but can also involve extraarticular organs. The most frequent presentation of RA is prolonged early morning or inactivity morning stiffness, joint swelling, symmetrical polyarthritis of the small joints. Without adequate treatment, patients may experience a progressive decline in joint function and mobility [1]. (ref). Extra-articular manifestations are observed in approximately 40 % of patients and including eye, skin and lung involvement [2]. Although well-characterized antibodies such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) are commonly associated with the disease, they are not essential for diagnosis. Approximately 10–50 % of the RA patients are seronegative for both RF and anti-CCP [3].

RA treatment was once limited to non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids prior to use of the conventional synthetic DMARDs (csDMARDs). While these agents provided symptomatic relief, they were insufficient to prevent disease progression. Methotrexate (MTX) soon became the anchor drug for RA management; however, nearly half of the patients do not respond adequately to MTX monotherapy [4]. This unmet need has led to numerous clinical trials investigating molecules that target key inflammatory pathways. This effort has paid off with development several biologic and targeted synthetic therapies against Tumor Necrosis Factor-α (TNF-α), interleukin-6 (IL-6), B and T cells, Janus Kinase (JAK).

The expansion of the therapeutic armamentarium in RA has paralleled a significant change in treatment paradigm—from a disease-centered model to a more patient-centered approach. The latter incorporates shared decision-making, functional goals, and patient-reported outcomes into clinical care. Furthermore, the concept of precision medicine started to take prominence, with a focus on tailoring treatment to individual patient and disease characteristics, including laboratory and imaging biomarkers and multi-omics [5]. Although precision medicine in RA remains an emerging field, the use of biomarkers and stratified treatment strategies represents a promising step toward more targeted treatment choices, tailored to individual needs. This approach also raises the possibility for entering and sustaining remission for each patient.

In this review, we provide a concise overview of the evolving treatment landscape In RA. We discuss the immunological basis of RA, current standard therapies, and emerging treatments, including targeted synthetic agents and precision medicine strategies. Finally, we outline key challenges and future directions toward more personalized and effective care.