Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent synovial inflammation and progressive joint destruction. This study aims to explore the intricate pathological mechanisms of RA and evaluate the impact of contemporary pharmacologic treatments. A comprehensive literature review and meta-analysis were conducted, synthesizing data from clinical trials, cohort studies, and systematic reviews. Key pathological mechanisms identified include the roles of pro-inflammatory cytokines (TNF-α and IL-6), autoantibodies (RF and ACPA), and dysregulated immune cells (T cells and B cells). The study highlights the efficacy of biologic DMARDs (TNF inhibitors, IL-6 receptor antagonists, B-cell depleting agents) and targeted synthetic DMARDs (JAK inhibitors) in reducing disease activity and improving functional outcomes. Despite their efficacy, these treatments are associated with adverse events, primarily infections, necessitating careful patient monitoring. The findings underscore the importance of early and aggressive intervention, the potential of combination therapies, and the need for personalized treatment approaches. Future research should focus on long-term safety and developing biomarkers for tailored therapies to enhance patient outcomes and quality of life.