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Treating rheumatoid arthritis

A look at the options.

People who have been diagnosed with rheumatoid arthritis, or RA, have a better outlook today than in the past. That's because treatment for this condition has greatly improved.

Doctors now know that early and aggressive treatment can help slow or stop the inflammation and joint damage caused by the disease.

People with RA usually need to try several treatment strategies during their lifetimes. The goals of any RA treatment are the same, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

  • Relieve pain.
  • Reduce inflammation.
  • Slow or stop joint damage.
  • Improve the person's ability to function and their sense of well-being.

Here's an overview of the various treatment options for RA.

Lifestyle changes

According to the NIAMS, the following lifestyle changes are an important part of treating RA:

Balance your rest and exercise. Moderate exercise helps keep muscles strong and joints moving smoothly. It also can help ease pain and improve your mood. Walking and other low-impact activities are good choices, but scale back to gentle range-of-motion exercises (like stretching) when your symptoms flare up. Take rest breaks, but avoid long periods in bed.

Take care of your joints. Using devices such as long-handled shoehorns and zipper pullers can ease the strain on your joints. Supporting a joint with a splint for a short time can reduce pain and swelling.

Eat right. A nutritious diet can help you stay healthy and control your weight—excess pounds put more stress on your joints. Some foods, such as fish, may help reduce inflammation. Be cautious about drinking alcohol. It can cause problems with some arthritis medicines.

Reduce stress. Feeling stressed can worsen pain. Try controlling stress by making time to relax and do something you enjoy. Exercising also helps control stress.

Medicines

Most people with RA also take medicines, according to the NIAMS. To decide which ones to prescribe, doctors consider the person's general health, the severity of his or her RA, and the medicine's effectiveness and possible side effects. According to the American College of Rheumatology and the NIAMS, you might take one of these:

Disease-modifying antirheumatic drugs (DMARDs). Initially, doctors prescribed these medicines only after RA symptoms became severe. But now people are given them right away, because they can slow or stop joint damage before it becomes severe. It's important to note that you may need to take a DMARD for weeks or months before the drug starts working.

Examples of DMARDs include methotrexate, hydroxychloroquine, leflunomide and sulfasalazine.

It's important to keep in touch with your doctor while taking these medicines. They can cause fever, nausea, skin rash, increased risk for serious infections, and other side effects.

Biologic response modifiers, or biologic agents. These drugs are a type of DMARD. They are genetically engineered medicines that work by blocking parts of the immune system and the signals that lead to inflammation and joint and tissue damage. Biologic agents are sometimes used for people who have serious RA or those who have not responded to treatment with traditional DMARDs. They are most effective when used in combination with a traditional DMARD, such as methotrexate.

Examples of biologic agents include abatacept, etanercept, infliximab and rituximab.

Since biologics suppress the immune system, they lead to an increased risk for infections and other problems. Your doctor will monitor you closely for these.

Anti-inflammatory drugs. These include nonsteroidal anti-inflammatory drugs (NSAIDs), which relieve pain and inflammation, and corticosteroids, which relieve inflammation. However, they can cause serious side effects when taken for a long time. For example, NSAIDs can cause gastrointestinal bleeding and ulcers. Corticosteroids can cause osteoporosis, increased appetite, elevated blood sugar levels and other problems. Be sure to take these medicines exactly as your doctor recommends.

Surgery

Some people with severe joint damage from RA benefit from surgery. For example:

  • Knees, hips and other joints can be replaced with artificial components.
  • Bones may be fused together to increase stability and relieve pain. This is usually done in ankles, wrists, fingers and toes.
  • Tendons damaged by RA can be reconstructed. This is typically done in the hand.

Ongoing care

People with RA should make regular visits to their doctor. These visits can help you find the combination of treatments that is best for you.

According to the NIAMS, the key to living well with RA lies with you, the patient.

Research suggests that people who are active in their own care report less pain, fewer doctor visits and a better quality of life than those who don't take an active role in their care.

So learn all you can about the disease, and try to be an active participant in your care. Your doctor can help.

Reviewed 12/13/2023

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