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Managing Inflammation and Rheumatoid Arthritis

Updated on March 24, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Nyaka Mwanza

If you’re among the 1.5 million adults living with rheumatoid arthritis (RA) in the United States, getting your inflammation under control is one of your primary treatment goals. Your rheumatologist and other health care providers will likely recommend a combination of various treatments and strategies. These regimens include medication, lifestyle changes, and integrative complementary treatments (nontraditional, non-Western practices like nutritional supplements, acupuncture, and tai chi).

What’s the Connection Between Rheumatoid Arthritis and Inflammation?

Inflammation is one of the main symptoms of RA (considered to be an inflammatory disease and a rheumatic disease) and is directly caused by the disease. Inflammation can also be used to measure disease improvement or worsening. When RA causes inflammation, it generally produces swelling, tenderness, and redness of the lining of the joints. It can also be very painful. Inflammation and the resulting pain and stiffness can range from uncomfortable to debilitating. When compounded by other arthritis symptoms, it can disrupt activities of daily living and drastically affect one’s quality of life.

About Rheumatoid Arthritis

RA is an autoimmune disease and a type of inflammatory arthritis that primarily affects the joints. Autoimmune conditions are the result of a person’s immune system mistakenly targeting its own healthy cells as if warding off an external threat (such as a virus or bacteria). This overactive immune response causes RA symptoms including inflammation, joint pain, and morning stiffness. Unlike osteoarthritis, these symptoms last longer than 30 minutes. Left untreated, RA can cause irreversible joint damage.

Related: How doctors measure inflammation when diagnosing RA

Inflammation and Health Complications

The chemicals the body produces in response to inflammation are harmful to the body. That’s why RA can lead to other problems and can become a threat to your overall health. RA and inflammation can cause problems in the eyes, lungs, and heart. Forty percent of people with RA experience symptoms outside of their joints (extra-articular symptoms). People with RA commonly have lung issues caused by inflammation that, in serious cases, can make it difficult for a person to breathe. Another inflammation-related health complication from RA is heart disease. Studies have shown that people with high levels of C-reactive protein (CRP) — a chemical produced in response to and a marker of inflammation in the body — are at greater risk of having a heart attack. People with RA tend to have elevated CRP levels due to the autoimmune response happening throughout their bodies.

Medications for Managing Inflammation

To manage their inflammation, people with RA usually take a combination of prescription and over-the-counter anti-inflammatory and pain-relief drugs.

Prescription Medications

Most people with RA are prescribed disease-modifying antirheumatic drugs (DMARDs), both nonbiologic and biologic types. These drugs help to control inflammation and slow disease progression. Nonbiologic DMARDs include:

  • Hydroxychloroquine
  • Leflunomide
  • Methotrexate
  • Minocycline
  • Sulfasalazine

Biologic DMARDs are a newer class of medication. They work in very targeted, specific ways to control RA’s inflammatory immune response. Biologics aren’t usually a first-line treatment for RA and are generally used in combination with other DMARDs and therapies to control symptoms and slow progression. Some biologic DMARDs used to treat RA include:

  • Abatacept
  • Adalimumab
  • Etanercept
  • Infliximab
  • Rituximab

DMARDs are effective in reducing overall inflammation. A 2017 study showed that a reduction in CRP levels and cholesterol levels lowered the risk of cardiovascular complications such as premature heart disease.

One myRAteam member mentioned, “I’m starting biologics soon because I have bad pain, and my inflammation levels have doubled.” Another member responded, “Good to hear you are getting treatment. I have been receiving monthly biologic infusions with minimal side effects, just a little fatigued the day after. Hope your infusion goes well.”

Nonprescription Anti-inflammatory Measures

There are several options to treat inflammation that don’t require a prescription. Some topicals (creams or gels that one applies to the skin) and patches can provide both anti-inflammatory effects and pain relief. Nonsteroidal anti-inflammatory drugs like naproxen (Aleve) also have anti-inflammatory properties. Even something as simple as applying ice to swollen, painful joints alleviates pain by decreasing inflammation.

Dietary Impact on Inflammation

Not only is being overweight a risk and exacerbating factor for RA, maintaining a healthy weight can help stop RA from worsening. It’s in the best interest of your overall health, especially if you have RA, to maintain a healthy weight. Your dietary habits are an important part of that.

Research has shown that certain foods can reduce inflammation and other arthritis symptoms. Some foods can also exacerbate inflammation or trigger arthritis symptom flare-ups.

There isn’t a special “arthritis diet” for RA. Generally speaking, a heart-healthy, balanced diet (as recommended by the American Heart Association) consists of antioxidant-rich foods, fruits and vegetables, whole grains, and “good fats” (e.g., olive oil and fish oil). Avoiding processed foods and refined sugars (in some cases cutting out gluten) may also help control RA-related inflammation and reduce RA flares.

As one myRAteam member described their diet, “​​I don’t eat highly processed or fast foods, and all my meals are cooked at home. Avoiding inflammatory foods and trying to go for as much as I can that reduces inflammation. Luckily, I really love fresh fruits and veggies.”

The Mediterranean diet emphasizes polyunsaturated fats (“good fats”), which are rich in omega-3 fatty acids. Omega-3 fatty acid lowers inflammatory markers such as CRP. Omega-3 and omega-6 fatty acids in combination have been found to also help with RA pain. The anti-inflammatory diet is beneficial to people living with RA. Aptly named, this diet emphasizes foods with strong anti-inflammatory effects such as those rich in antioxidants. Some inflammatory foods that the diet recommends people with RA limit or avoid include red meat, trans fats like margarine, corn oil, and deep-fried foods.

Physical Activity Can Help Control Inflammation

Ensuring you’re regularly physically active is an important part of managing your RA and minimizing inflammation. Adults should aim for 150 minutes of moderate or low-impact physical activity per week such as walking, swimming, or yoga. It can be hard to get moving when you’re coping with RA symptoms. Make sure you’re exercising safely and listening to your body. Do less when your symptoms are worse. Get your 30 minutes in by doing three ten-minute sessions, one in the morning, afternoon, and evening.

If you have RA, regular exercise has the following added benefits:

  • Lowers the risk of developing chronic diseases like obesity, heart disease, osteoarthritis, and diabetes
  • Improves mental health by lowering the risk of depression and other mood disorders associated with a chronic condition like RA
  • Helps maintain a healthy weight, which can slow the worsening of RA

Rest and Relaxation for Inflammation Management

It can be hard to get a good night’s sleep when you’re in pain or if your RA inflammation is flaring up. But when you don’t get enough good sleep, your RA symptoms can be more severe. One study found that pain and sleep problems in combination with RA, result in higher CRP levels and other inflammatory markers. Pain relief and ample, high-quality sleep every night can improve symptoms of RA.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis, more than 181,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA. Here, coping with the challenges of inflammation is among the most-discussed topics.

How do you find relief from RA inflammation? How do you manage the pain associated with inflammation? Join the myRAteam conversation today. You’ll be surprised how many others may have similar stories.

References
  1. Arthritis by the Numbers — Arthritis Foundation
  2. Rheumatoid Arthritis (RA) — Centers for Disease Control and Prevention
  3. Rheumatoid Arthritis — Mayo Clinic
  4. What You Need to Know About RA and Lung Disease — Arthritis Foundation
  5. The Association Between Reduction in Inflammation and Changes in Lipoprotein Levels and HDL Cholesterol Efflux Capacity in Rheumatoid Arthritis — Journal of the American Heart Association
  6. American College of Rheumatology 2008 Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis — Arthritis & Rheumatism
  7. Rheumatoid Arthritis — American College of Rheumatology
  8. Disease Modifying Anti-Rheumatic Drugs (DMARD) — StatPearls
  9. Key Public Health Messages About Arthritis — Centers for Disease Control and Prevention
  10. Foods That Can Help RA Symptoms — Arthritis Foundation
  11. 8 Food Ingredients That Can Cause Inflammation — Arthritis Foundation
  12. Managing Rheumatoid Arthritis with Dietary Interventions — Frontiers in Nutrition
  13. New Look at Nutrition Research Identifies 10 Features of a Heart-Healthy Eating Pattern — American Heart Association
  14. Can Rheumatoid Arthritis Be Modified With an Anti-Inflammatory Diet? — Practical Pain Management
  15. Six Keys to Reducing Inflammation — Scripps
  16. Physical Activity for Arthritis — Centers for Disease Control and Prevention
  17. Relationship Between Sleep, Pain, and Inflammatory Markers in Patients With Rheumatoid Arthritis — Journal of Caring Sciences
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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