Rheumatoid Arthritis

Rheumatoid arthritis is most often treated with medicine, exercise, and lifestyle changes. Treatment may help relieve symptoms and control the disease, but there is no cure. Treatment for rheumatoid arthritis usually continues throughout your life, but will vary depending on:

• The stage (active or in remission) and severity of your disease.
• Your treatment history.
• The benefits and risks of treatment options.
• Your preferences for treatment options, such as cost, side effects, and daily schedules.

The goal of treatment is to help you maintain your lifestyle, reduce joint pain, slow joint damage, and prevent disability.

Initial treatment

Treatment of rheumatoid arthritis should start with education about this disease, the possibility of joint damage and disability, and the risks and benefits of potential treatments. A long-term treatment plan should be developed by you and your health professional team.⁶

The purpose of early treatment is to:

• Relieve or reduce pain.
• Reduce joint inflammation.
• Improve daily function.
• Prevent or delay significant joint damage and deformity.
• Prevent permanent disability.
• Improve the quality of life.

Experts recommend early and aggressive treatment of rheumatoid arthritis with medicines called disease-modifying antirheumatic drugs (DMARDs) that can actually slow or sometimes prevent joint destruction.⁶ Examples of DMARDs include:

• Methotrexate.
• Etanercept.
• Adalimumab.
• Abatacept.
• Infliximab.
• Leflunomide.
• Sulfasalazine.
• Hydroxychloroquine sulfate.

One study suggested that advances in the treatment of rheumatoid arthritis, including DMARDs, has improved the health of people with the disease over the last 20 years.⁷ DMARD treatment, begun as soon as possible after diagnosis and continued for a prolonged period of time, may prevent damage to joints and other complications of rheumatoid arthritis.⁸

Joint pain, tenderness, and swelling are the most important means of measuring how the disease is progressing or responding to treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or analgesics (pain relievers, such as acetaminophen, codeine, or hydrocodone) may be used to relieve these symptoms. NSAIDs relieve pain and lower inflammation. Analgesics relieve pain but do not affect inflammation. These medicines do not change the course of the disease or prevent joint destruction. Analgesics or NSAIDs are used as helpers in combination with DMARDs.

Corticosteroids may be used to treat your rheumatoid arthritis. They may be used as:

• Initial therapy until a DMARD has a chance to work (bridge therapy).
• A means of controlling flares of rheumatoid arthritis. When a single joint is inflamed, a corticosteroid injection can be effective in relieving symptoms.
• Disease management when DMARDS do not fully control the disease.

Because of the side effects of corticosteroids, your health professional will use the lowest possible dose and will try to reduce and eventually discontinue use of oral corticosteroids. But this is not always possible.

Exercise, physical therapy, and lifestyle changes can help you decrease joint pain. Many people with rheumatoid arthritis benefit from self-management plans that balance rest and activity. Steps you can take at home to relieve your symptoms and help control your disease include:

• Becoming involved in the day-to-day management of your disease. For more information, see:

  Arthritis: Managing rheumatoid arthritis.

• Staying active physically, mentally, and socially.
• Resting when you are tired.
• Protecting your joints from injury.
• Eating a balanced diet.
• Exercising regularly.
• Controlling your weight.

Ongoing treatment

Treatment for rheumatoid arthritis usually continues throughout your life. Your health professional will want to closely monitor your condition. A rheumatologist should evaluate you regularly. Depending on your symptoms and treatment, this could be done as often as every 2 to 3 months or as infrequently as every 6 to 12 months. Testing, such as blood tests, may be done more often.

During each follow-up visit, your health professional will assess how active your disease is. Markers of disease activity are:

• The amount of joint pain.
• How long morning stiffness lasts.
• The number of actively inflamed joints.
• How well you are functioning.
• Results of tests (erythrocyte sedimentation rate [ESR] or C-reactive protein)

Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, etanercept, adalimumab, infliximab, and leflunomide, will probably be used early in the course of your disease and for a prolonged period after treatment begins. DMARDs have been shown to slow the disease and may prevent joint destruction.

Corticosteroids may be used to treat your rheumatoid arthritis. They may be used as:

• Initial therapy until a DMARD has a chance to work (bridge therapy).
• A means of controlling flares of rheumatoid arthritis. When a single joint is inflamed, a corticosteroid injection can be effective in relieving symptoms.
• Disease management when DMARDS do not fully control the disease.

Because of the side effects of corticosteroids, your health professional will use the lowest possible dose and will try to reduce and eventually discontinue use of oral corticosteroids. But this is not always possible.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or analgesics (pain relievers, such as acetaminophen) also may be used to relieve symptoms. NSAIDs can relieve pain and reduce inflammation in less severe cases of rheumatoid arthritis.

Exercise, physical therapy, and lifestyle changes can help you decrease joint pain. Many people with rheumatoid arthritis benefit from self-management plans that balance rest and activity. Steps you can take at home to relieve your symptoms and help control your disease include:

• Becoming involved in the day-to-day management of your disease. For more information, see:

  Arthritis: Managing rheumatoid arthritis.

• Staying active, physically, mentally, and socially.
• Resting when you are tired.
• Protecting your joints from injury.
• Eating a balanced diet.
• Exercising regularly.
• Controlling your weight.

Treatment if the condition gets worse

In some cases of rheumatoid arthritis, the disease does not respond to the first several treatments. Treatment-resistant rheumatoid arthritis may be treated with much higher doses of medicines or with different combinations of medicines. Surgery may be considered when the joints—especially the hips, knees, or feet—are severely damaged or deformed and are causing extreme pain. Surgery may include total joint replacement or other techniques to improve joint function.

What to Think About

Treatment to manage rheumatoid arthritis can be effective at slowing the progression of the disease, and you may have periods of time in which the disease is in remission. But if you have joint destruction from rheumatoid arthritis, you may need treatment such as pain relief, physical therapy, and/or surgery.

The course of rheumatoid arthritis is difficult to predict, and some people respond to treatment better than others. Scientists are studying the role that a person's genes may play in disease progression.⁹