Rheumatoid arthritis is a chronic and progressive inflammatory disorder, characterised by synovitis

and severe joint destruction (M Feldermann, FM Brennan, RN Maini, 1996). The incidence and
prevalence studies of R.A suggest a considerable variation of the disease among different population
(Y Alamanos, AD Drosos, 2005). More studies on the incidence and prevalence in southern Africa are
needed. R.A affects about 1% of the world’s population ( need reference ). Its incidence is two or
three times greater in women , this discrepancy is seen mostly before the 5 th decade ( ref needed ). The
incidence of R.A increases till the 7th decade when it the begins to taper off ( ref needed).
R.A is a complex condition involving the following characteristics:
 Synovial cell proliferation
 Fibrosis
 Synovitis
 Pannus formation
 Cartilage and bone destruction
Cytokines, prostanoids and proteolytic enzymes are accepted mediators in the development and
sustained disease mechanism of R.A (P Tak, B Bresnihan, 2000; 43:2619-26633). That said , new
developments regarding oxidative stress and hypoxia in the microenvironment of R.A have been
researched. A study done by C.A Hitchon and H.S El-Gabalawy dicusses the role of oxidation in R.A
suggesting that Pannus formation is due to a tumour-like proliferation process. A study by T Gaber ,
R Dziurla, R Tripmacher, G.R Burmester and F Buttergeit (2005 ) looks at how Hypoxia inducible
factor (HIF) contributes to the progression and persistence of arthritis. HIF a transcriptional factor
which responds to alterations in oxygen concentrations, it is a key coordinator of gene expression
involved in the persistence of synovitis.