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Pain Management and Rheumatoid Arthritis

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Rheumatoid Arthritis Drugs

There are many drugs available to decrease joint pain, swelling and inflammation, and possibly prevent or minimize the progression of the disease.

Medications that offer relief of arthritis symptoms (joint pain, stiffness, and swelling) include:

  • Anti-inflammatory painkiller drugs, such as aspirin, ibuprofen, or naproxen
  • Topical (applied directly to the skin) pain relievers
  • Corticosteroids, such as prednisone. They can be injected directly into joints.
  • Narcotic pain relievers

There are also many strong medications called disease-modifying antirheumatic drugs (DMARDs) that are used to treat RA. These drugs usually work by interfering with or suppressing the immune system attack on the joints. They include:

  • Anti-malaria medications, such as hydroxychloroquine
  • Chemotherapy drugs, such as methotrexate, Imuran, and Cytoxan
  • Organ rejection drugs, such as cyclosporine
  • Biologic treatments, such as Actemra, Cimzia, Enbrel, Humira, Kineret, Remicade, Orencia, Rituxan, and Simponi
  • Miscellaneous drugs, such as Azulfidine, penicillamine, gold, and minocycline
  • Arava
  • Xeljanz

Some of these medications are traditionally used to treat other conditions such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ. However, when chemotherapy drugs (such as methotrexate or Cytoxan) are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer treatment.

The biologic treatments in particular have greatly improved the long-term outcomes for many people with RA. However, they are very expensive and are given either by self injection or by intravenous infusion. By altering the immune system, they also can increase the risk of serious infection and so are often chosen for those with more severe disease.

When Is Surgery Necessary?

When joint damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.

Why Is Rest and Exercise Important for RA?

A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest the joints that are inflamed. This may be accomplished by the temporary use of a cane or joint splints.

When joint inflammation is decreased, guided exercise programs are necessary to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility.

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