Treatment for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-term (chronic) autoimmune disease. Autoimmune means that your immune system begins to attack and damage healthy cells.

Damage from RA can continue over time and lead to worse symptoms. Inflammation causes these symptoms. While RA is known as a joint disease, many other areas of the body are also affected by it. As the disease progresses, treatment for RA may change.¹

The progression of RA is not the same for everyone. The overall course of the disease can vary from person to person, depending on several factors:¹

• Genes
• Number and severity of symptoms
• Presence of inflammatory proteins in the blood

Knowing the goals of RA treatment, the drug and non-drug options, and possible surgical options will help you better understand RA treatment.

RA treatment goals

Treatment of RA has 3 main important goals. These include:^2,3

• Providing control of symptoms, including inflammation, pain, swelling, and joint dysfunction
• Preventing damage to joints and related structures
• Helping each person with RA maintain the ability to function and overall quality of life

Drugs for RA are either disease-modifying treatments or symptomatic treatments. These drugs have different goals:⁴

• Disease-modifying treatments change the course of RA and slow or prevent joint destruction while relieving symptoms.
• Symptomatic treatments mainly focus on relieving symptoms.

Drugs for RA

Disease-modifying anti-rheumatic drugs (DMARDs)

Traditional DMARDs, also called conventional DMARDS, decrease inflammation and work to slow or prevent further damage to the joints. The most common DMARD is methotrexate. This drug was first used as a cancer-fighting drug. It is now a first-line treatment for RA.⁴

Targeted synthetic DMARDs (tsDMARDs)

TsDMARDs are designed to target a specific protein in the body. The main class of tsDMARDS is Janus kinase (JAK) inhibitors. "Janus kinases" are proteins that signal cells to produce pro-inflammatory chemicals. JAK inhibitors decrease inflammation by reducing these signals. Common JAK inhibitors include tofacitinib, baricitinib, and upadacitinib.^5-8

Biologic DMARDs

Biologics are a type of DMARD made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. This process uses the cells to produce the biologic drug. Examples of biologics include Enbrel® (etanercept) and Humira® (adalimumab).^3,4

Steroids

Steroids (corticosteroids) are very effective at controlling inflammation. They may be taken in pill form, injected into a vein or muscle, or directly injected into a joint cavity. Steroids rapidly improve pain, stiffness, swelling, and inflammation. Unlike DMARDs, steroids do not slow or prevent RA-related damage to joints and other structures.⁴

Steroids are typically used during an RA flare. Common steroids include:⁴

• Prednisone
• Prednisolone
• Methylprednisolone

Non-steroidal anti-inflammatory drugs (NSAIDs)

Many NSAIDs are available over-the-counter, such as ibuprofen. NSAIDs can help provide fast relief of RA symptoms such as pain and minor inflammation. Talk to your doctor about the right dose to use for the NSAID you are taking. Like all drugs, NSAIDs can cause side effects.⁴

Other medications for pain relief

Several classes of drugs provide pain relief but do not have any effect on inflammation. These include:⁴

• Analgesic pain relievers, such as Tylenol (acetaminophen)
• Narcotic (opioid) pain relievers, such as codeine, oxycodone, and hydrocodone

Narcotic drugs can cause dependency. In general, these drugs are discouraged due to the potential for dependence with long-term use.⁴

Surgical procedures

Because RA can damage joints, surgery plays an important role in RA treatment. Various surgical options are available for relieving joint pain and restoring joint function.⁹

Synovectomy

Synovectomy is typically performed using thin instruments placed into the joint through small incisions (arthroscopically).⁹

Synovectomy removes part of the lining of the joint, called the synovium. In RA, inflammation can thicken the synovium. The inflamed synovium releases enzymes that destroy cartilage and bone. The goal of synovectomy is to prevent or stop further damage to the joint.⁹

Joint replacement (arthroplasty)

Arthroplasty is known as joint reconstruction or replacement. Replacement of damaged joints can relieve pain and restore joint function. Arthroplasty can involve different combinations of artificial (prosthetic) and natural components. The approach depends on joint location and the nature of joint damage. The procedure is performed under general anesthesia by an orthopedic surgeon.⁹

Arthrodesis

In arthrodesis, the affected joint is joined together (fused). This eliminates both motion and discomfort. This surgery is considered a "last resort" treatment. In certain joints where the range of motion is less critical, such as in the heel or big toe, this surgery can provide symptom relief.⁹

Non-drug management approaches

There are a variety of non-drug management approaches to RA. These methods include:^2,3

• Education and counseling
• Mental and social support
• Biofeedback, a mind-body technique to help gain control of your body
• Cognitive-behavioral therapy (CBT), known as talk therapy
• Rest
• Diet and exercise
• Physical and occupational (functional) therapy
• Self-help strategies
• Complementary and alternative medicine approaches, such as acupuncture or capsaicin ointment made from peppers