The Ups and Downs of Treatment: RA Tells a Complex Story

3 min read

We continue to raise awareness about rheumatoid arthritis (RA) during Arthritis Awareness Month. Join us each week as we highlight different parts of the RA journey. In our first article, we talked about RA symptoms and diagnosis. In this second article, we are focusing on treatment.

But first, take our quick poll below. How many RA medications did you try before you found what works best for you and your RA?

What is the goal of RA treatment?

RA is a 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. While RA is known as a joint disease, many areas of the body are affected by RA inflammation. The progression of RA looks different for each person. As the disease progresses, treatment for RA may change.^1,2

There are 3 main goals of RA treatment. These are:^3,4

Providing control of symptoms, including inflammation, pain, and swelling
Preventing damage to joints and other parts of the body
Maintaining the ability to function and overall quality of life

To achieve these treatment goals, your doctor may talk to you about options like traditional DMARDS (like methotrexate), biologics, or JAK inhibitors. Your doctor may also talk to you about non-drug management approaches such as:^3,4

Cognitive-behavioral therapy (CBT)
Diet and exercise
Physical and occupational (functional) therapy
Complementary and alternative medicine approaches

For many, finding treatment for RA can be challenging. Below, click the title to read the personal stories of how people with RA have navigated their treatment journey.

Better understanding RA treatment

The Persistence of Pain
Kelly Mack
"These results suggest that RA pain is not solely related to inflammation but has other origins or contributions to the pain experience. While treatment that quiets the disease and inflammation activity can help with pain, it seems pain also comes from other sources."

What’s Your Target?
Carla Kienast
"There will be compromises. My current RA treatment plan hits nearly every personal target I have. My 1 complaint is it’s an infusion and I have really bad veins. The fact that my doctor is also hitting the targets she’s set for my treatment makes us both happy. So talk to your doctor about what your targets are."

JAK Inhibitor vs Biologic DMARD: What Is the Difference?
RheumatoidArthritis.net Editorial Team
"A JAK inhibitor can be used for moderate to severe RA when the first drug for treating RA does not work well enough, or if the first therapy causes unpleasant side effects. Or it can be added to another treatment, like methotrexate. Combining the 2 can help some RA patients achieve better results. Also, JAK inhibitors are taken orally instead of as injections or infusions."

Can a Blood Test Predict Treatment Response in RA?
Lisa Emrich
"A recent study suggests that laboratory tests may be helpful in predicting which patients with rheumatoid arthritis will respond to disease-modifying anti-rheumatic drugs (DMARDs). With so many treatment options available for RA, wouldn’t it be great to know in advance which treatments are most likely to work for an individual patient?"

What to Ask Your Doctor Before Starting a Biologic for RA
Amanda Osowski
"Asking all of your questions before beginning any new medication, let alone a biologic, is so critical to your comfort and success with a new treatment plan. Additionally, connecting with other patients who have been on that medication can help support you by learning about patient perspectives and recommendations."

Join the conversation

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Effie Koliopoulos Moderator & Contributor
Informative article! Thanks for writing this. Not many recommend CBT in their articles enough. There's so much more people can do than just changing diets and getting more active. Mental and emotional health is such an unmet need, and misunderstood one. -Effie, moderator
sonial1t6 Member
This article is helpful for those beginning their RA journey. May I add that the JAK inhibitors/biologics should be very carefully scrutinized by you and your rheumatologist with respect to your medical history and your family’s history of disease. I was extremely fortunate to have a very smart, very caring rheumatologist, who helped navigate me through the various RA medications, when DMARDS caused adverse reaction, to manage my disease. For example, the JAK inhibitors, according to each biologic's own medical documentation, may cause a perforation in the colon and/or rectal tissues that increase the risk of certain cancers (colon, rectum, lung, thyroid). According to a TNF inhibitor’s own medical documentation, it has been shown to exacerbate lupus or connective tissue symptoms. For a IL6-inhibitor, its own medical documentation shows how it may increase hypertension and the risk of certain cancers (colon, rectum, lung, thyroid). According to the National Institute of Health, 0.3% of RA patients treated with ——— experienced drug-induced systemic lupus erythema. (See <a href='https://pubmed.ncbi.nlm.nih.gov/11867114/' target='_blank' rel='noopener noreferrer ugc'>https://pubmed.ncbi.nlm.nih.gov/11867114/</a>.) Lucky me. For the great majority of patients who develop a prescribed drug-induced disease, the drug-induced symptoms disappear or decrease significantly within six (6) months after termination of the prescribed drug. My blood draw a full year after termination of ———, continued to show a strong positive for anti-DNA, an indicator for lupus erythema. Now two years later, still a strong positive for anti-DNA, and lupus symptoms have manifested. Also, as one of my orthopedists, for I have a different orthopedist for my different body parts affected, at one of the most prestigious medical centers in the world said, “The hope is that the RA medications will slow down the progression of the disease. At least, that’s the hope.”
1. christine.laaksonen Community Admin
 <inline-mention username="sonial1t6" user-id="3199785"/> Thanks for your comment and providing so much information. It sounds like you have had very helpful and supportive doctors. -- Warmly, Christine (Team Member)