Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) has no cure, but doctors recommend that patients use aggressive treatments early in diagnosis to decrease the severity of symptoms. There are a variety of treatment methods used to control symptoms and stop joint damage, including medications, surgery, and daily routine and lifestyle changes. Communication with a doctor or rheumatologist is necessary in choosing effective treatments. They will ensure that treatments are healthy and medications prescribed correctly for a patient’s situation or lifestyle.

Treating RA will not cure the disease, but certain treatments can significantly reduce the pain and potential permanent damage to the body. Depending on the severity of your symptoms, the goals of treatment will be to gain “tight control” of RA, meaning the disease’s activity is kept steadily at a low level. Keeping RA in “tight control” can prevent long-term joint damage.

These goals primarily focus on:

  • Reducing inflammation
  • Preventing further or permanent damage
  • Improving quality of life
  • Reducing daily and long-term side effects

Following a strict treatment regimen could bring RA into remission, meaning there are no signs of the disease in the body. Remission is never an indication that symptoms will not return, but many patients can go long stretches of time without symptoms.

There are many ways to treat rheumatoid arthritis and a doctor or rheumatologist are the only ones who can help determine which methods are the best for a patient’s individual needs.

Medications for RA Treatment

Doctors prescribe medications to reduce inflammation and to relieve joint pain caused by RA. The medications used to treat RA often come with serious side effects, so doctors typically start by prescribing lower doses. This is most beneficial to RA patients who are in the early stages of the disease, because symptoms are still subtle.
Those in progressed stages of RA need more aggressive treatment to reduce inflammation and other effects, so stronger medications are given. Unfortunately, these drugs often come with more dangerous side effects.

Here are the different medications usually prescribed for rheumatoid arthritis patients:

NSAIDs, or non-steroidal anti-inflammatory drugs, are medications meant to relieve pain and reduce inflammation. They can be bought over-the-counter or stronger doses can be prescribed. Many people are already familiar with NSAIDs because they are used to treat headaches, fevers and other common ailments safely at home. Ibuprofen (Advil, Motrin IB) and naproxen (Aleve) are two basic NSAIDs that will reduce pain and inflammation temporarily. Weaker NSAIDs come with little side effects or risks but they also only manage symptoms and pain — they will not help with slowing disease activity.

Stronger NSAIDs are available with a prescription and can provide increased pain relief while reducing inflammation throughout the body. NSAIDs with stronger doses come with serious side effects, including:

  • Liver damage
  • Ringing in the ears
  • Heart problems
  • Upset stomach
  • Kidney damage

There are special prescription NSAIDs that are safer for people prone to stomach problems. NSAIDs can be taken orally or applied directly to the joint as a patch or cream.

Corticosteroid medications work in your body similar to hormones as they try to slow the progression of the disease and stop the immune system from attacking healthy tissue. They can be taken as pills, liquids or shots and contain Methylprednisolone, Prednisolone and Prednisone. Corticosteroids offer pain relief but they come with possible side effects that are less than ideal.

Possible side effects include:

  • Leg swelling
  • Weight gain
  • Increased blood pressure
  • Mood swings

Studies have shown that using corticosteroids over long periods of time can result in more serious and permanent side effects. These include:

  • High blood sugar or even diabetes
  • Increased risk of infection
  • Calcium deficiency leading to weak bones
  • Easy bruising on the skin

For this reason, doctors usually only prescribe corticosteroid medications for a short amount of time to reduce symptoms, and then place patients on less dangerous regimens or over-the-counter drugs.

DMARDs, or disease-modifying antirheumatic drugs, are long-term medications mean to slow or alter the progression of rheumatoid arthritis by stopping the immune system from attacking healthy tissue. These drugs protect joints and tissues from permanent damage and gradually reduce daily pain. DMARDs can be taken concurrently or with other pain relievers.

Examples of traditional DMARDs are:

  • Methotrexate (Trexall)
  • leflunomide (Arava)
  • Hydroxychloroquine (Plaquenil)
  • Sulfasalazine (Azulfidine)

Side effects are different for each patient and medication, but the most serious are liver damage and susceptibility to infections.

There is a subset of DMARDs called biologic response modifiers. These drugs target specific parts of the immune system that trigger inflammation. One might target and block TNF inhibitors or the activation of T cells, which all plays a role in causing inflammation in the joints. By blocking specific steps in the process, these drugs prevent the entire immune response from being wiped out and vulnerable at once. This greatly reduces the risk of infection. Biologic agents are typically prescribed along with other medications to effectively fight RA symptoms.

Common biologic agents are:

  • Abatacept (Orencia)
  • Adalimumab (Humira)
  • Anakinra (Kineret)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Rituximab (Rituxan)
  • Tocilizumab (Actemra)

JAK Inhibitors, such as Xeljanz, are another type of DMARDs that work against the pathways that increase the body’s immune response, known as Janus kinase. JAK inhibitors are helpful because they can be taken by mouth, unlike biologics, and they work well with traditional DMARDs. JAK inhibitors can dramatically decrease inflammation.

Physical Therapy

Keeping an active, healthy lifestyle is just as important in treating RA symptoms as the right combination of medications. Exercise may seem too painful, but low-risk exercises like walking and yoga can actually reduce inflammation. A physical therapist can help you design a safe, effective daily workout routine that will keep joints flexible.

Life with RA is difficult and not being physically able to do certain tasks can lead to frustration. Physical therapists can help patients discover new ways of approaching tasks that involve as little strain as possible.

Surgery

Surgery is a drastic treatment for RA and is usually reserved for those with severe joint damage. No amount of medications can restore damage or fix deformities caused by RA, but surgery can restore abilities lost to RA and repair crucial parts of joints.

There are three surgical procedures that RA patients typically receive. These are:

  • Joint replacement — surgeons remove part of your damaged joint and insert a prosthetic replacement
  • Joint fusion — when replacements aren’t possible, surgeons can fuse and realign joints
  • Tendon repair — over time, inflammation can damage tendons. Surgeons can fix these damaged tendons, which will strengthen your joints

For more information on managing Rheumatoid Arthritis and improving symptoms, visit our Living with RA section.

View Sources Last Edited: August 3, 2016

Sources and Citations

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3. “Diseases and Conditions: Rheumatoid Arthritis.” Treatments and Drugs. Mayo Foundation for Medical Education and Research, n.d. Web. 03 Aug. 2016. http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/treatment/con-20014868

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