While there is currently no cure for rheumatoid arthritis (RA), there are now more treatments than ever before. Guidelines for RA treatment generally recommend trying the safest treatments first and moving to more intensive treatments with more serious potential side effects if the first-line treatments fail. Guidelines also take into account the severity and extent of joint damage caused by RA.
Rheumatoid arthritis treatments may be taken orally or administered via injection. Your doctor may recommend both over-the-counter and prescription medications. Surgery may also be helpful in some cases involving extensive joint damage. Some people with rheumatoid arthritis feel better when they change their diet or try complementary or alternative therapies, such as acupuncture or acupressure.
NSAIDs work well for mild or moderate pain and inflammation. Some NSAIDs such as Aspirin, Advil (Ibuprofen), and Aleve (Naproxen) are available over the counter, while Celebrex (Celecoxib), Mobic (Meloxicam), and Voltaren (Diclofenac) require a prescription. NSAIDs are believed to work by inhibiting the production of chemicals that promote inflammation and blood clot formation in the body. Taken regularly at high doses, some NSAIDs can cause gastrointestinal problems and abnormal bleeding.
Prescribed treatments that slow disease progression are referred to as disease-modifying antirheumatic drugs. DMARDs modulate the immune system to calm inflammation and reduce autoimmune attacks on the joints, as well as ease symptoms. Most people with RA take one or more DMARDs on a long-term, maintenance basis to slow disease progression and help prevent flares. Some DMARDs are taken orally, while others are injected subcutaneously (into the skin) or intravenously (into the veins). Biologic drugs are a newer class of DMARDs designed to suppress specific aspects of the immune system responsible for inflammation in RA.
DMARDs taken orally include older, traditional drugs such as Methotrexate, Azulfidine (Sulfasalazine), and Plaquenil (Hydroxychloroquine), as well as the biologic drugs Xeljanz (Tofacitinib), Olumiant (Baricitinib), and Rinvoq (Upadacitinib). Methotrexate may be given intramuscularly during severe RA flares.
Most injected medications are biologics. Remicade (Infliximab) is administered as an intravenous infusion. Simponi (Golimumab), Enbrel (Etanercept), Humira (Adalimumab), Orencia (Abatacept), and Cimzia (Certolizumab pegol) can be self-administered as subcutaneous injections. Biologic drugs for RA are generally indicated to be injected once every few weeks.
DMARDs can cause desirable effects and unwanted side effects on a systemic basis throughout the body. Since DMARDs suppress aspects of the immune system, many of these RA treatments can increase your risk for contracting infections and, in rare cases, developing certain types of cancer. Each RA treatment has specific side effects and different levels of risk. Your doctor can help you understand the benefits and risks of each RA medication based on your medical history and individual condition.
Corticosteroids, or simply steroids, are mainly used short-term to control RA symptoms during disease flares. Corticosteroids are synthetic hormones that suppress immune system response. Cortisone, Prednisone, and the closely related drug Acthar Gel are examples of corticosteroids. Corticosteroids are believed to work by inhibiting or blocking inflammatory responses within the body. Steroids may be taken orally, injected into joints, or given intravenously. Used over a long period or at high doses, steroids cause problems such as Cushing’s syndrome, a metabolic disorder that involves weight gain, muscle weakness, high blood pressure, and high blood sugar.
Not everyone who has rheumatoid arthritis will need surgery. In fact, thanks to earlier diagnosis and newer, more effective DMARDs, fewer people with RA require surgery to repair joints now than ever before.
If joints do become damaged by RA to the point where surgery is necessary, there are several different surgical options. Arthroplasty, or joint replacement, is the most common technique used for severe knee and hip problems. Arthrodesis, or joint fusion, is used to stabilize and relieve pain in wrists, ankles, spine, fingers, and thumbs. In earlier stages of RA, synovectomy, or removal of portions of inflamed synovial membrane that lines the inside of joints, may improve pain in wrists and knees. Tendon repair can restore function to joints when RA leads to weakening and tearing.
There is no specific diet that helps everyone with rheumatoid arthritis. Many physicians and researchers studying the effects of nutrition in people with RA recommend a balanced diet with plenty of fresh fruit and vegetables, whole grains, and unsaturated fats. Maintaining a healthy weight can help reduce the severity and symptoms of RA. People with RA have a higher risk for developing dangerous conditions, such as diabetes and heart disease. A balanced, nutritious diet can help lower the risk. Some people with RA report reduced symptoms after they adopted an anti-inflammatory diet or when they avoided foods such as meat, dairy, or nightshade vegetables (tomatoes, potatoes, and related plants).
Some people with RA do not get sufficient amounts of certain nutrients. You can ask your doctor to test your blood levels of important nutrients and recommend nutritional supplements if needed.
People with RA are less likely to exercise than those without RA. Pain, stiffness, and swelling lead many people with RA to give up on exercise and become increasingly sedentary. However, exercise has been proven to reduce pain and improve sleep and quality of life with those who have RA. Conversely, lack of physical activity can lead to increased stiffness and contribute to the development of other serious conditions, such as obesity, osteoporosis, heart disease, diabetes, and depression. Research has proven that regular exercise helps people with RA maintain a healthy weight, keep joints flexible, and reduce inflammation and stress.
Some people with RA have reported feeling better after trying various complementary or alternative therapies, such as acupuncture, herbal supplements, or Ayurvedic medicine. Natural treatments cannot replace clinically proven medications. No alternative treatments have been proven effective in studies to prevent flares or delay disease progression. Since some natural treatments, such as nutritional or herbal supplements, can interfere with RA medications or cause their own side effects, it is important to talk to your doctor before trying alternative therapies.
Any medication can cause side effects. Each RA treatment has specific potential side effects associated with it. This does not mean that anyone who takes that RA medication will experience all, most, or any of the side effects it can potentially cause. Some side effects are very common, while some are extremely rare. Risk for side effects may depend on your age and genetic background, and whether you are taking any other medications or have any other health conditions. Your doctor can help you assess the risks and benefits of each RA treatment as they relate to your medical history and condition. Read more about the side effects of individual treatments.
Most people with private or employer-sponsored health insurance are eligible for copay assistance programs through the manufacturers of biologic treatments. Some people with low income and no health insurance may qualify for free RA medications through nonprofit organizations or drug manufacturers.
Despite encouraging research, there is presently no cure for RA. The good news is that while RA is not yet curable, it is treatable.