Reducing symptoms and long-term complications, such as pain and joint swellingGetting joint inflammation under tight control or stopping it altogether (putting the disease in remission)Minimizing joint and organ damageImproving physical function and quality of life
Drugs, physical therapy, and surgery are proven therapies for rheumatoid arthritis.
Treat-to-Target for Rheumatoid Arthritis
Treat-to-target is a new treatment paradigm for rheumatoid arthritis that involves doctors and patients having an open and ongoing discussion about the target for treatment. This is important for shared decision-making. This process involves patients describing their treatment goals, acceptable pain levels, and requirements for conducting daily functions. From there, the patient and doctor come up with a reasonable disease target — high, moderate, or low disease activity or full remission — and determine how to get there. The physician continually monitors (using standardized tools) disease activity and explains why specific therapies are being used, and the patient shares his or her symptoms and experiences. For optimized care, the physician will adjust the medications and therapies accordingly on an ongoing basis.
This strategy essentially amounts to treatment with anti-inflammatory drugs, and sometimes more than one medication at a time. There are three main categories of medication for rheumatoid arthritis:
Disease-modifying antirheumatic drugs (DMARDs), including biologic DMARDs and targeted synthetic DMARDs called JAK inhibitorsCorticosteroidsNonsteroidal anti-inflammatory drugs (NSAIDs)
Disease-Modifying Antirheumatic Drugs for RA
These drugs each work differently, but ultimately alter or slow the course of RA by suppressing the body’s overactive immune system or inflammatory processes. A class of DMARDs called biologics work by targeting the specific steps in the inflammatory process. Biologic DMARDs work faster than conventional DMARDs — some within two weeks, while conventional DMARDS may take a few months. Biologics are created from living cells and are usually used to treat moderate to severe RA, as well as patients who have not responded well to conventional DMARDs or other treatments. The first conventional biologics that became available work to inhibit tumor necrosis factor (TNF) alpha, a pro-inflammatory substance in the immune system. Anti-TNF drugs, or TNF inhibitors, include:
Enbrel (etanercept) — self-injectionRemicade (infliximab) — infusionHumira (adalimumab) — self-injectionCimzia (certolizumab) — self-injectionSimponi (golimumab) — self-injection
They’ll teach you joint protection techniques, such as how to maintain proper body position and posture, body mechanics for specific daily functions, and how to distribute pressure to minimize stress on individual joints. Occupational and physical therapists can also teach you about the hand exercises that are best for you.
The Importance of Hand Exercises and Rest
The joints of the hands are among the first to be affected by RA, and over time inflammation can cause carpal tunnel syndrome and loss of hand and finger function. Research published in July 2017 in the journal Arthritis Care & Research found that grip strength initially increased in study participants with early RA within their first year of diagnosis. This early improvement was likely due to anti-rheumatic treatments. But some hand exercises may improve grip strength and finger range of motion for RA patients. These exercises can include, among others:
Opening and closing your hands repeatedlyPinching your fingers together (touching your thumb to the tips of your other fingers)Touching your thumb to the base of your other fingersMaking a loose fist by drawing your fingers to the center of your palmsMoving your wrists up and downMoving your hands in nice, easy circlesPutting your hands flat on a table and raising your fingers up individually
These exercises should be interspersed with hand rest. Learn More About Rheumatoid Arthritis and Diet
Some complementary or alternative therapies, such as homeopathy, hydrotherapy, or cryotherapy, might help relieve RA symptoms, though the clinical evidence supporting these methods has been inconclusive. You might want to explore therapies such as acupuncture, tai chi, and yoga. While some people have found these approaches helpful, the research overall hasn’t found clear, definitive benefits. You should always check with your medical provider before trying any complementary or alternative therapies. You’ll also want to check with your doctor before using home remedies to relieve the pain and inflammation from a flare-up. At-home treatments that may help soothe pain and stiffness include hot or cold treatments, over-the-counter topical pain relievers, and braces or splints that support the joints. Learn More About Alternative Therapies and Home Remedies for Rheumatoid Arthritis A surgeon may operate to:
Clean out inflammation-causing bone and cartilage fragments from the joint, fix tears in soft tissues around joints, or repair damaged cartilage and ligaments (arthroscopy)Remove some or all of the inflamed joint lining (synovectomy)Fuse a joint (arthrodesis) so that it no longer bends and is properly aligned and stabilizedReplace a joint (arthroplasty), particularly of the ankles, shoulders, wrists, and elbows, with an artificial one made of plastic, ceramic, or metalRemove only a certain section of a damaged and deformed knee joint (osteotomy)
RELATED: It’s Time to Reframe Chronic Pain While DMARDs slow disease progression and reduce inflammation, they’re not used to treat acute pain management. Instead, doctors typically recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen sodium) and prescription Diflunisal (dolobid), and, for a brief duration, corticosteroids, such as prednisone and prednisolone. RELATED: 8 Great Pain Relievers You Aren’t Using Medical marijuana is frequently prescribed for chronic pain, but the research is lacking when it comes to treating RA pain. It’s generally a matter of weighing the benefits and risks of medical marijuana for RA — it does reduce pain and has anti-inflammatory effects, but some doctors hesitate to prescribe it for rheumatic conditions because of the mental and cardiac-related side effects. RELATED: Cannabis for Arthritis: Why Don’t We Know More by Now?
Exercise for RA Pain Management
Learn More About Rheumatoid Arthritis Pain Management
