Expert Advice on How to Treat Rheumatoid Arthritis

When you're trying to figure out how to manage the pain and stiffness that come with RA, you'll have lots of questions about how to sort through the options. We spoke with Ana-Maria Orbai, MD, assistant professor of medicine in rheumatology at Johns Hopkins Medicine in Baltimore, to get ideas on how you can make a plan that's right for you.

Which medicines treat rheumatoid arthritis?

We have multiple families of medications. We still have the traditional medications known as disease-modifying antirheumatic drugs [DMARDs]. These drugs don't just relieve symptoms, they actually slow the progression of the disease.

Then we have … targeted medications (biologics and small molecules) to treat rheumatoid arthritis and prevent disease progression. If one medication doesn't work or if a person can't use it for whatever reason, we can move to other medications or we can combine medications.

How well do RA drugs work?

They are very effective. In the past, people with rheumatoid arthritis might have had trouble opening a jar. When properly treated, some people can run 5 miles. 

How soon should you start taking medicine?

Damage from rheumatoid arthritis cannot be reversed, so the key is to treat it as soon as possible. 

Are there ways to manage fatigue?

Often you can treat fatigue by treating rheumatoid arthritis. In some cases, the rheumatoid arthritis improves but not the fatigue. This is more difficult to handle. The advice is to be as active as you can. Physical activity is also important to preserve muscle mass.

What type of exercise is good for people with RA?

I encourage any type of physical activity that the person feels is beneficial to them and doesn't cause pain. There's no single activity. Doing something you enjoy is important.

People should also listen to their bodies. Don't do what hurts. Pain is clearly a signal that you're close to injury, if not already causing injury.

Are there other lifestyle changes people can make?

The No. 1 thing is quitting smoking. People with RA who smoke are less likely to respond to therapy.

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The second thing is keeping a healthy weight. Someone who has a healthy weight is more likely to keep their joints in shape than someone with an unhealthy weight. Eating a healthy diet is also important.

What about vitamins?

There are no specific vitamin recommendations for people with rheumatoid arthritis, although we do notice that people with rheumatic disease have low vitamin D. It's important to take vitamin D with rheumatoid arthritis because you also have a high risk of osteoporosis. 

Can any alternative therapies help?

A yoga study ... found preliminary evidence that yoga may ease pain, reduce stress, and improve mood in people with rheumatoid arthritis. The study also found that yoga can build lower-body strength.

Do ice packs and heating pads help?

Heat can be helpful to relieve slowness and stiffness in the joints. Some people find cold packs to be helpful when joints are inflamed. 

What about home and workplace adjustments?

If there's disability, occupational therapists and physical therapists can advise you on how to modify your environment to compensate for the rheumatoid arthritis. Again, there's no universal rule because each person is different.

Is surgery ever necessary?

Hopefully there's no need for that. There is a risk of more wear and tear when the joints are inflamed, so some people need to get joint replacement at an earlier age. It may be needed if there's a lot of pain and you're not able to move the joint comfortably.

Is attitude important?

Definitely, and being willing to work with the doctor. I find it useful when patients are proactive in bringing up concerns. That's the purpose of every doctor's visit: to see if remission has been achieved. Are we at [the] goal? If not, we need to change something.

WebMD Feature Reviewed by Michael W. Smith, MD on October 17, 2019

Sources

SOURCES:

Ana-Maria Orbai, MD, assistant professor of medicine in rheumatology and director, Psoriatic Arthritis Program, Johns Hopkins Medicine, Baltimore.

Bartlett, S.J. Current Rheumatology Reports, December 2013.

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