Figure 1: Development of the rheumatoid arthritis and the onset of flares involves a multistep process. Predisposing factors were categorized into immune modulators and environmental factors. Genetic risk factors include genes in immune modulation (e.g. HLA-DR4 shared epitope, PTPN22, TNFα polymorphisms and the detoxification pathways (e.g. GST1null [52]) [1] and references therein). Diets that contain > 5:1 omega 6 to omega 3 fatty acids increase the risk for prolonged inflammation [6]. One of these potential triggering events often coupled with an emotional stress is associated with the onset of RA, although other causes which induce 34-54% of RA cases have yet to be elucidated [8]. Patients exposed to additional triggering events can experience further RA progression and flares. This figure was inspired by Figure 1 from McInnes and Schett [1].