RA Treatment Overview
Strategies for Treatment of RA
Damage to joints from rheumatoid arthritis (RA) can happen very early in the course of the disease, within the first two years after diagnosis. Therefore, early diagnosis and prompt initiation of an effective treatment program is crucial to ensuring that damage is minimized and functional ability and quality of life are maintained.
There are a range of treatment or management approaches in RA, including drug therapy, rehabilitation and physical therapy, nutrition, psychosocial interventions, complementary and alternative treatment approaches, and surgical interventions. As you work with your doctor to develop a holistic approach to RA, you may adopt some or all of these approaches as part of a comprehensive management strategy.
It is important to note, however, that the only treatment modality for which there is clear evidence of efficacy in slowing or preventing joint damage is drug therapy, specifically with disease-modifying anti-rheumatic drugs (DMARDs), including both traditional DMARDs, such as methotrexate, newer biologics, and target-specific DMARDs. Biosimilars are also available, which provide clinically similar efficacy to biologic DMARDs. Since these drug treatments are associated with side effects, risks must be weighed against benefits and choice of individual agents should take into account the specific safety issues associated with each agent.
Goals of RA treatment
Treatment of RA has several important goals. These include1:
- Provide control of symptoms, including inflammation, pain, swelling, and joint dysfunction
- Prevent damage to joints and related structures
- Help the patient to maintain the ability to function and overall quality of life
Non-drug management approaches
There are a variety of non-drug management approaches to RA. Many of these should be an essential part of every patient’s tool kit in managing RA. These include1:
- Education and counseling
- Psychosocial support
- Cognitive behavioral therapy
- Rest and relaxation
- Physical and occupational therapy
- Nutrition and dietary therapy
- Self-help strategies
- Complementary and alternative medicine approaches
Drug treatments are an essential part of managing RA, especially during periods when the disease is active. DMARDs, including traditional, biologics, biosimilars, and target-specific, have been shown to slow and prevent damage to joints and preserve function and improve quality of life.
Drug treatment generally fall into two categories, symptomatic treatments (those drugs whose main focus is relief of symptoms) and disease-modifying treatments (those drugs that can modify the course of RA and slow or prevent joint destruction in addition to providing relief of symptoms).
Choice of drug treatment, as well as the intensity of that treatment (whether one or more drugs are used), will depend on individual factors including the severity of RA and side effects associated with treatment. Your doctor will work closely with you to strike the right balance in suppressing RA-related inflammation (and other symptoms), while keeping side effects to a minimum. This is the key challenge of drug treatment in RA. To get the balance right, your doctor may adjust the dose of your RA medication or switch to another that has a different track record for efficacy or side effects.1
There are several classes of drugs that are commonly used to treat RA and its symptoms. Symptomatic drug treatments include NSAIDs, glucocorticoids (also called corticosteroids or just steroids), and pain medications. Drugs that slow bone erosion may also be considered symptomatic treatments. DMARDs (including traditional agents, such as methotrexate, and newer biologics, such as TNF-inhibitors) comprise the group of medications that provide relief of symptoms and protect against the damaging effects that RA inflammation has on joints and related structures.1
Surgical procedures in RA
Because of the potential for damage to joints and related structures in RA, surgery plays an important role in treatment. Various surgical options are available for relieving joint pain and restoring joint function. Available options vary from joint to joint, and range from minimally invasive arthroscopic procedures to partial and complete joint replacement.2
- Zampeli E, Vlachoyiannopoulos PG, Tzioufas AG. Treatment of rheumatoid arthritis: unraveling the conundrum. J of Autoimmunity. 2015 Oct;65:1-18. http://dx.doi.org/10.1016/j.jaut.2015.10.003.
- Simmen BR, Bogoch ER, Goldhahn J. Surgery insight: orthopedic treatment options in rheumatoid arthritis. Nat Clin Pract Rheumatol. 2008 May;4(5):266-73. doi: 10.1038/ncprheum0767. Epub 2008 Mar 11.