RA most often requires lifelong treatment, including medicines, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can with newer drug categories can be very helpful slowing joint destruction and preventing deformities.
Disease modifying antirheumatic drugs (DMARDs): These are often the drugs that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs.
- Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) and hydroxychloroquine may also be used.
- Sulfasalazine is an anti-inflammatory drug that is often combined with methotrexate and hydroxychloroquine (triple therapy).
- These drugs may have serious side effects, so you will need frequent blood tests when taking them.
Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
- Although NSAIDs work well, long-term use can cause stomach problems, including ulcers and bleeding, and possible heart problems.
- Celecoxib (Celebrex) is another anti-inflammatory drug. Drugs in this class (COX-2 inhibitors) may increase heart attack and stroke risk for some people. Talk to your doctor about whether these medicines are right for you.
Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil). They are most often used along with methotrexate. It may be weeks or months before you see any benefit from these drugs.
Corticosteroids: These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible.
Biologic agents: These drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.
They may be given when other medicines for rheumatoid arthritis have not worked. Sometimes biologic drugs are started sooner, along with other rheumatoid arthritis drugs.
Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). There are different types of biologic agents:
- White blood cell modulators include: abatacept (Orencia) and rituximab (Rituxan)
- Tumor necrosis factor (TNF) inhibitors include: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certolizumab (Cimzia)
- Interleukin-6 (IL-6) inhibitors: tocilizumab (Actemra)
Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:
- Infections from bacteria, viruses, and fungi
- Leukemia or lymphoma
- Allergic reactions
- Janus kinase inhibitor: Tofacitinib (Xeljanz). This is a medicine taken by mouth that is now approved for treating RA.
Surgery may be needed to correct severely damaged joints. Surgery may include:
- Removal of the joint lining (synovectomy)
- Total joint replacement in extreme cases; may include total knee, hip replacement, ankle replacement, shoulder replacement, and others
Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.
Sometimes, therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.
Other therapies that may help ease joint pain include:
- Joint protection techniques
- Heat and cold treatments
- Splints or orthotic devices to support and align joints
- Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night
Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eat foods rich in fish oils (omega-3 fatty acids). Smoking cigarettes should be stopped. Excessive alcohol should also be avoided.