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 5th 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: y Synovial cell proliferation y Fibrosis y Synovitis y Pannus formation y 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.

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