Rheumatoid arthritis presents several challenges in diagnosis and management that must be addressed early. A delayed diagnosis is a critical pitfall, because at the beginning the symptoms may be minimal and mimic other conditions, leading to progressive joint damage, eventually systemic complications, and reduced treatment efficacy. On the other hand, overdiagnosis may occur if patients are treated very early without meeting diagnostic criteria and indications for initiating treatment. Additionally, suboptimal treatment strategies may further exacerbate disease progression and possible complications. Treatment side effects in rheumatoid arthritis patients, such as liver toxicity or infection risks, require continuous monitoring and patient education to ensure adherence and safety. When it comes to systemic complications of the disease, such as cardiovascular and pulmonary complications, clinicians should be vigilant and should not overlook them as they contribute to morbidity and mortality. Additionally, depression and fatigue are under-recognised, despite their impact on quality of life and treatment adherence. As rheumatoid arthritis is a systemic disease and may present complications from several organ systems, a multidisciplinary management should be approached for optimal outcomes.