Treatment for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic (long-term) 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. The inflammation of the disease causes these symptoms. While RA is known as a joint disease, many areas of the body are also affected by it. As the disease progresses, treatment for RA may change.1,2

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 various 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:3,4

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

Drugs for RA are either symptomatic treatments or disease-modifying treatments. These drugs have different goals:5

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

Disease-modifying anti-rheumatic drugs (DMARDs)

Traditional DMARDs

Traditional 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 but is now a first-line treatment for RA.5

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 turns the cells into drugs that can treat RA. Examples of biologics include Enbrel® (etanercept) and Humira® (adalimumab).4,5

Non-steroidal anti-inflammatory drugs (NSAIDs)

Many NSAIDs are available over-the-counter (OTC), 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 whichever NSAID you are taking. Like all drugs, NSAIDs also can cause side effects.5

Steroids

Steroids (corticosteroids) are very effective at controlling inflammation. They may be taken in pill form, injected into a vein or muscle, or by direct injection into a joint cavity. Steroids have been shown to rapidly improve pain and tenderness, stiffness, swelling, and inflammation. Unlike DMARDs, steroids do not slow or prevent RA-related damage to joints and other structures.5

Steroids are typically used during an RA flare. Prednisone, prednisolone, and methylprednisolone are common steroids.5

Medications for pain relief

Several different classes of drugs provide pain relief in RA, but do not have any effect on inflammation. These include:5

  • Pain relievers (analgesics), such as Tylenol (acetaminophen)
  • Narcotic-like drugs, such as Ultram® (tramadol)
  • 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. Also, narcotic drugs do not affect inflammation.5

Surgical procedures

Because of the potential for damage to joints and related structures, surgery plays an important role in RA treatment. Various surgical options are available for relieving joint pain and restoring joint function.6

Synovectomy

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

Synovectomy removes part of the lining of the joint, called the synovium. In RA, inflammation can cause a thickening of the synovium. The inflamed synovium releases enzymes that can destroy cartilage and bone. The goal of synovectomy is to prevent or stop further damage to the joint.6

Joint replacement (arthroplasty)

Arthroplasty is known as joint reconstruction or replacement. Replacement of damaged joints can both relieve pain and restore joint function. There are several different options for joint replacement. Arthroplasty can involve different combinations of artificial (prosthetic) and natural components. The approach depends on joint location and the nature of damage to joints and related structures. The procedure is performed under general anesthesia by an orthopedic surgeon.6

Arthrodesis

In arthrodesis, the affected joint is fused (joined together). 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.6

Non-drug management approaches

There are a variety of non-drug management approaches to RA. Many of these include:3,4

  • 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 cream or ointment made from peppers

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Written by: Katie Murphy │Last reviewed: April 2021