Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) is an autoimmune disease that causes your immune system to attack healthy tissue, leading to inflammation in the joints. In the early stages, RA often affects the joints in your hands, feet, and knees. If left untreated, your condition can progress to other parts of the body, like the elbows, ankles, and hips. This is why it’s important to seek care as soon as you start experiencing symptoms. 

While there is no known cure for RA yet, starting treatment early can stop or slow your condition from progressing. However, even if you get a late diagnosis, treatment can help reduce flare-ups and improve your overall quality of life.

Your healthcare provider or rheumatologist (a medical doctor who specializes in the diagnosis and treatment of arthritis and other autoimmune diseases) will usually recommend a combination of medication, therapy, and self-care strategies to treat RA. In more severe cases, surgery may also be necessary.

Medication

Several different types of drugs, from over-the-counter or prescription pills to intravenous (IV) injections are used to treat RA.  Medication can help reduce pain and prevent future damage to your joints and bones. 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are typically the first line of treatment that your healthcare provider will recommend. Most people with RA use NSAIDs to reduce joint pain and swelling. Over-the-counter (OTC) NSAIDs such as ibuprofen (Advil), aspirin (Bayer), and naproxen (Aleve) are widely available at local drug stores and pharmacies. For severe pain, your provider may prescribe you stronger NSAIDs.

You may have constipation, gas, or bloating after taking NSAIDs. While these side effects can feel uncomfortable, they are usually normal. However, if you experience stomach bleeding or severe abdominal pain, see your healthcare provider for alternative options. Your provider can also help you determine which OTC drug and dosage is safest for you. 

COX-2 Inhibitors

COX-2 inhibitors are another type of anti-inflammatory drug, which are commonly labeled as Celebrex in drug stores. They offer the same relief of joint inflammation like NSAIDs do, but cause less severe stomach-related symptoms. You may still experience constipation, diarrhea, or stomach pain after use.

Researchers suggest that COX-2 inhibitors are generally safe for most people with RA. However, you and your healthcare provider should be cautious and use other medications if you have heart disease, hypertension, or fluid retention.

Corticosteroids

Corticosteroids such as prednisone and hydrocortisone are a stronger type of anti-inflammatory medication. They can help reduce severe joint pain without causing stomach-related complications that can occur when you take NSAIDs. But, they are not completely risk-free. 

This medication has a different set of side effects, which may include thinning of the skin and bones, increased appetite that can cause weight gain, water retention, or high blood pressure—especially if you use them too often. Your provider will likely prescribe you corticosteroids in low doses and for short-term use to help prevent these symptoms.

Conventional Disease-Modifying Antirheumatic Drugs (DMARDs) 

Conventional disease-modifying antirheumatic drugs (DMARDs) can prevent further damage to your joints by slowing down the immune response that causes your body to attack the healthy tissue in your joints. DMARDs address the cause of the symptoms, not the symptoms themselves.

Unlike other pain medications like NSAIDs that can help you with quick relief, you may not notice the effectiveness of DMARDs such as hydroxychloroquine (Plaquenil) and methotrexate (Otrexup) for up to 12 weeks. That said, your healthcare provider may recommend taking an anti-inflammatory drug and a DMARD together to enhance your treatment and manage symptoms faster. In some cases, your provider may suggest combination therapy or taking more than one DMARD at a time—especially if one medication alone is not improving your symptoms. 

Side effects for every type of DMARD vary, but nausea and diarrhea are common. Because DMARDs work to reduce inflammation by suppressing an overactive immune response, you may also have a higher risk of developing infections. Your healthcare provider may frequently monitor your overall health if you are taking DMARDs. If you begin to experience any complications after starting this medication, your provider may try alternative options. 

Biologics

Biologics are a newer type of DMARD that come in the form of self-injections or intravenous (IV) infusions. Typically, people with RA don’t need to take biologics because conventional DMARDs and other anti-inflammatory medication help manage their symptoms well. However, your healthcare provider may recommend biologics if conventional DMARDs are not effective. Like conventional DMARDs, it is usually safe to also take biologics with NSAIDs. 

While conventional DMARDs try to suppress your immune system as a whole, biologics work by blocking the specific proteins in your immune system that are attacking healthy joint tissue. Biologics tend to be more difficult to administer and are more expensive than conventional DMARDs, but generally, work well in those who have had little success with other medications. 

There are four main types of biologics that are currently used to treat RA. These include:

• Tumor necrosis factor alpha (TNF-α or just TNFs) inhibitors 
• B-cell inhibitors
• Interleukin inhibitors
• Selective costimulation T-cell modulators 

Each type of biologic targets a different protein in the immune system and has its own list of risks and benefits. However, all biologics may put you at a higher risk of developing infections because this medication suppresses your overactive immune system. You may also experience slight pain and redness in the area where the IV was put in.

Self-Care Strategies 

Receiving a diagnosis for RA is a big change and it’s normal to feel overwhelmed as you adjust to a new lifestyle. In addition to medication, your healthcare provider may also recommend some of these self-care strategies that you can do at home to help manage your symptoms.  

• Do low-impact exercises: The pain and fatigue that RA can cause might make exercise feel like a chore. But, exercising can help you keep your joints flexible and your joint muscles strong—which can improve your range of motion and help relieve symptoms. Stretching, yoga, tai chi, and walking are all exercises that keep your body moving without putting as much strain on your joints.
• Get good sleep: If you have trouble falling or staying asleep with RA, you are not alone. Studies show that nearly 70% of people with RA also experience sleep problems. Being well-rested can help reduce the frequency and pain of RA flare-ups. Setting a sleep schedule and sticking to it, taking your medications on time, and avoiding caffeine and alcohol before bed can improve your sleep. If your symptoms keep you up at night, talk to your healthcare provider about trying a different medication or a higher dose.
• Take breaks: When you are experiencing a flare-up, try to take breaks in between activities and chores. Overworking your body can worsen joint pain and swelling. It might be hard for you to cancel plans or take on fewer obligations, but talking to your loved ones about your condition can help. This might help your loved ones understand what you are going through and in doing so, they may help you balance your responsibilities with rest.
• Try hot and cold compresses: If you are in a flare-up, try alternating hot and cold compresses to give your joints some relief. Hot showers or baths and heating pads can relax the muscles around your joints. Using an ice pack wrapped in a towel can help reduce pain and swelling. Limit your hot and cold compresses to about 15 minutes, as too much exposure could cause skin burns or frostbite. 
• Take care of your mental health: Living with a chronic condition like RA can cause stress, depression, and worry. Learning how to reduce stress can help you manage your pain better and improve your quality of life. Meditation, spending time with loved ones, journaling your thoughts, or talking to a mental health professional may be good ways to tend to your emotional well-being.

Physical and Occupational Therapy

Many people with RA find it helpful to add therapy to their treatment plan. Your healthcare provider can refer you to a physical therapist, occupational therapist, or both, to help you better manage your symptoms.  While physical therapy and occupational therapy can overlap at times, each treatment helps you with different goals. 

• Physical therapy (PT): The main focus of PT is to improve your ability to move and help you gain strength. Each PT session can look different—you might be learning how to do low-impact exercises one day while getting a massage the next. Over time, this treatment may reduce stiffness and swelling. Physical therapists can also teach you how to properly use hot and cold compresses and recommend which braces or splints you can wear to ease joint pain. 
• Occupational therapy (OT): The goal of OT is to help you do daily activities like getting dressed, cooking, or typing on the computer with less pain and fatigue. Occupational therapists can teach you how to make items in your home more accessible (e.g., putting plates and cups on a lower shelf) or pick out the right assistive devices if you need one (e.g., suitcases with wheels or a walking cane). OTs can help you with modifying your daily activities to gradually improve your quality of life.

While physical and occupational therapies can be a great way to manage your symptoms, they are not a replacement for medication. If either of these treatments sounds like they could be a good fit for your goals, reach out to your healthcare provider to find a therapist who can work with you and your medication plan. 

Surgery

Generally, surgery is a last-resort treatment and most people with RA don’t need surgical procedures. Those who get surgery are typically in an advanced stage of RA or haven’t had success with medication and therapy.

If your healthcare provider determines that surgery is the right next step, they will help you choose the type of surgery that is best for you. Your provider will evaluate your symptoms, treatment plan, family history, and overall health before referring you to an orthopedic surgeon—a surgeon who specializes in bones, joints, and muscles. 

The goals of surgery are to:

• Reduce pain and swelling
• Repair the function of your joints
• Increase your range of motion
• Prevent further damage 

Sometimes, you may need more than one type of surgery to improve symptoms. In this case, your care team will typically start with the joints that are causing the most pain and disruption to your daily life.  

Some common options for surgery may include:

• Arthroplasty: This surgery is known as joint replacement surgery and is commonly used on the hips and knees. An orthopedic surgeon will usually remove the damaged tissue and bone and replace it with metal or plastic implants. 
• Synovectomy: The synovium is the tissue that lines your joints, which often becomes inflamed in people with RA. During a synovectomy, surgeons remove this inflamed tissue to improve the range of motion in your joints. This type of surgery is usually performed on the knees. 
• Tenotomy: The purpose of this procedure is to repair any damage to your tendons, or the tissue that connects your muscles to your bones. This surgery involves making a cut in your tendon to relieve pressure and inflammation. It is most commonly done on the hands and fingers.
• Arthrodesis: This type of surgery connects multiple bones to a joint—also known as a joint fusion. A joint fusion might be necessary if you are experiencing too much pain in a smaller joint such as the ankles or wrists. An orthopedic surgeon will use metal rods or plates to remove the space in between your joints to connect the bones around the joint together. This can help reduce pain in the joint, but may also lower your range of motion; therefore, it is typically not recommended for larger joints like the hips or knees. 

Based on your condition, other types of surgery are also available. Each surgery has a different purpose and recovery time. Your healthcare provider and surgeon will help you figure out which surgery is best for your needs and overall health. They can also walk you through the surgical process and answer your questions and concerns.  

A Quick Review

The four most common types of treatment for RA include medication, self-care strategies, therapy, and surgery. In most cases, your healthcare provider will recommend a combination of these treatment options to help manage your condition. Your treatment plan will likely be based on the location, severity, and duration of your symptoms. 

Ultimately, the goal of treatment is to get you into remission or reduce your symptoms as much as possible while improving your quality of life. Keep in mind that you may not find the right combination of treatments right away. Working with your healthcare provider and learning what your body needs can help you and your care team figure out the treatment that is right for you.