Treatment usually includes medications, occupational or physical therapy, and regular exercise. Some people need surgery to correct joint damage. Early, aggressive treatment is key to good results. And with today’s treatments, joint damage can be slowed or stopped in many cases.
Drugs for Rheumatoid Arthritis
As part of rheumatoid arthritis treatment, your doctor will probably prescribe a nonsteroidal anti-inflammatory drug (NSAID). These medications reduce pain and inflammation but do not slow down RA. So if you have moderate to severe RA, you’ll probably also need to take other drugs to prevent further joint damage.
Over-the-counter NSAIDs include ibuprofen and naproxen. Most people with RA need a prescription NSAID as they offer a higher dose with longer-lasting results and require fewer doses throughout the day.
There are many prescription NSAIDs that your doctor will consider. All of them carry a warning about the increased risk of heart attack and stroke. NSAIDs can also raise blood pressure and can cause stomach irritation, ulcers, and bleeding.
You and your doctor can weigh the benefits of NSAIDs against the potential risks. You may have to try a few different ones to find the one that’s right for you.
“DMARDs” stands for disease-modifying antirheumatic drugs. They help slow or stop RA from getting worse.
Doctors usually first prescribe methotrexate to treat rheumatoid arthritis. If that alone doesn’t calm the inflammation, doctors may try or add a different type of DMARD. Other DMARDs include hydroxychloroquine (Plaquenil), leflunomide (Arava) and sulfasalazine (Azulfidine).
In rheumatoid arthritis, an overactive immune system targets joints and other areas of the body. DMARDs curb the immune system, but they aren’t selective in their targets. They can lead to infection and a wide variety of other side effects.
DMARDs, particularly methotrexate, have made dramatic improvements in severe rheumatoid arthritis and can help save your joints.
Tofacitinib (Xeljanz) is a different type of DMARD. Because it affects a specific part of the immune system involved in RA, it also has a risk of serious infection.
When methotrexate or other DMARDS don’t ease RA symptoms and inflammation, doctors may recommend a biologic. These are genetically engineered proteins. They block specific parts of the immune system that play a key role in inflammation of rheumatoid arthritis. They may slow or stop RA.
There are different biologics that target different parts of the immune system. Biologics include:
- Abatacept (Orencia)
- Adalimumab (Humira)
- Adalimumab-atto (Amjevita), a biosimilar to Humira
- Anakinra (Kineret)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Etanercept-szzs (Ereizi), a biosimilar to Enbrel
- Golimumab (Simponi, Simponi Aria)
- Infliximab (Remicade)
- Infliximab-dyyb (Inflectra), a biosimilar to Remicade
- Rituximab (Rituxan)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
Since biologics suppress the immune system, they raise the risk of infection. Severe infections have been reported with biologics.
For severe RA or when RA symptoms flare, your doctor may recommend steroids to ease the pain and stiffness of affected joints. In most cases, they can be used temporarily to calm a symptom flare. But some people need to take steroids for a longer time to control pain and inflammation.
You can get steroids as a shot directly into an inflamed joint or take them as a pill. These are not the type of steroids that bulk up your muscles.
Surgery for Rheumatoid Arthritis
If joint pain and inflammation become unbearable or joints are severely damaged, some people need joint replacement surgery. The hips and knees, and sometimes the shoulders, are the most common joints that get replaced. Surgery can dramatically improve pain and mobility. Most people wait until after age 50, because artificial joints tend to wear down after 15 to 20 years.
Some joints, such as the ankles, don't respond well to artificial replacement and do better with joint fusion, which is a different operation.
Physical and Occupational Therapy
Physical therapists can give you an exercise plan, teach you how to use heat and ice, do therapeutic massage, and encourage and motivate you.
Occupational therapists help you handle daily tasks -- like cooking or using your computer -- and show you easier ways to do those things. They can also check on whether any gadgets would help you.
How Cognitive Therapy Can Help
Because one of the most trying aspects of rheumatoid arthritis is learning to live with pain, many doctors recommend pain management training. They may call it “cognitive therapy.”
The goal is to improve your emotional and psychological well-being as you develop ways to relax, handle stress, and pace yourself. For instance, it may include activity scheduling, guided imagery, relaxation, distraction, and creative problem-solving.
Exercise, Joint Pain, and Rheumatoid Arthritis
When your joints are stiff and painful, exercise might be the last thing on your mind. Yet with RA, exercising regularly is one of the best things you can do.
- People who work out live longer, with or without rheumatoid arthritis.
- Regular exercise can cut down on RA pain.
- Your bones will be stronger. Thinning of the bones can be a problem with rheumatoid arthritis, especially if you need to take steroids.
- Stronger muscles help you move better.
- Your mood and energy level will benefit.
Natural Treatments for Rheumatoid Arthritis
There are some complementary medicine treatments that might help your RA. It’s a good idea to talk it over with your doctor. You’ll still need to take your medicine and keep up with the other parts of your treatment plan.
Heat and cold: Ice packs can reduce joint swelling and inflammation. Heat compresses relax muscles and stimulate blood flow.
Acupuncture: Studies show that acupuncture curbs pain, may lower the need for painkillers, and is good for flexibility in affected joints.
Mind/body therapy: Mind/body therapies can help with stress management, plus improve sleep and how you react to pain. Strategies include deep belly breathing, relaxing your muscles one by one from head to toe, visualization (such as picturing a calming scene), meditation, and tai chi.
Biofeedback: With biofeedback, you work with a therapist who helps you recognize when you feel tense and learn ways to calm yourself. This can help you handle pain.
Nutritional supplements: Keep in mind that even natural supplements can interact with medicines. So tell your doctor of all medicines and supplements you take. She can make sure they’re OK for you.
Research shows that omega-3 fatty acids in fish oil have an anti-inflammatory effect in the body. Several studies have shown that fish oil supplements may help reduce morning stiffness with RA.
Some studies show that borage seed oil along with anti-inflammatory painkillers can reduce RA symptoms. These studies show that in people with RA, joints were less tender and swollen after 6 weeks.
If you smoke, make it a priority to quit. If you keep smoking, it may make your RA treatment less effective.