RA Treatment: What is the Safest Treatment for Rheumatoid Arthritis?

Rheumatoid arthritis (RA) has no cure, but doctors recommend that patients adhere to suggested treatments early in diagnosis to decrease the severity of symptoms. There are a variety of treatment methods used to control symptoms and stop joint damage, including medications, surgery, and daily routine and lifestyle changes. Communication with a doctor or rheumatologist is necessary for choosing the most effective treatments. Your physician will ensure that treatments are safe and the medications are prescribed correctly based on each unique situation.

Treating RA will not cure the disease, but certain treatments can significantly reduce the pain and prevent permanent damage to the body. Depending on the severity of your symptoms, the goals of treatment will be to gain “tight control” of RA, meaning the disease’s activity is kept steadily at a low level. Keeping RA in “tight control” can prevent long-term joint damage.

These goals primarily focus on:

• Reducing inflammation
• Preventing further or permanent damage
• Improving the quality of life
• Reducing daily and long-term side effects

Following a strict treatment regimen could bring RA into remission. Remission means that the level of disease activity has decreased in the body.  It is never an indication that symptoms will not return, but following remission, many patients can go for long periods of time without experiencing symptoms.

There are many ways to treat rheumatoid arthritis, and a doctor or rheumatologist can help determine which methods are best for each patient’s individual needs.

These drugs target a particular portion of the disease pathway and help mitigate or control the symptoms of RA. These medications are not a cure, but they may offer patients with RA an opportunity to improve their quality of life by reducing the frequency and intensity of flare-ups.

Medications for RA Treatment

Doctors prescribe medications to reduce inflammation and to relieve joint pain caused by RA. The medications used to treat RA often come with serious side effects, so doctors typically start by prescribing lower doses. The treatment regimen is most beneficial to RA patients who are in the early stages of disease because during this time the symptoms are still relatively subtle.

Those with advanced stages of RA need more aggressive treatment to reduce inflammation, the time between exacerbations and other effects associated with the condition. This may often require stronger medications to be prescribed. Unfortunately, these drugs often come with more dangerous side effects.

Here are the different medications usually prescribed for rheumatoid arthritis patients:

NSAIDs, or non-steroidal anti-inflammatory drugs, are medications meant to relieve pain and reduce inflammation. They are available over-the-counter, and when needed, stronger doses may be prescribed. Many people are already familiar with NSAIDs because they are used to treat headaches, fevers and other common ailments safely at home. Ibuprofen (Advil, Motrin IB) and naproxen (Aleve) are two basic NSAIDs that will reduce pain and inflammation temporarily.

Weaker NSAIDs come with little side effects or risks but they also only manage symptoms and pain — they will not help with slowing disease activity.

Stronger NSAIDs are available with a prescription and can provide increased pain relief while reducing inflammation throughout the body. NSAIDs with stronger doses come with serious side effects, including:

• Liver damage
• Ringing in the ears
• Heart problems
• Upset stomach
• Kidney damage

There are prescription NSAIDs that are safer or gastrointestinal friendly for people prone to stomach problems. NSAIDs can be taken orally or applied directly to the joint as a patch or cream.

Corticosteroid medications or another form of drug used in the treatment of RA. They work in your body similar to hormones as they try to slow the progression of the disease and stop the immune system from attacking healthy tissue. They can be taken as pills, liquids or given as an injection by a provider. Some of the prescribed forms of corticosteroids include Methylprednisolone, Prednisolone, and Prednisone. Corticosteroids offer pain relief, but they also come with the potential for side effects.

Possible side effects include:

• Leg swelling
• Weight gain
• Increased blood pressure
• Mood swings

Studies have shown that using corticosteroids over long periods of time can result in more serious and permanent side effects. These include:

• High blood sugar or even diabetes
• Increased risk of infection
• Calcium deficiency leading to weak bones
• Easy bruising on the skin

For this reason, doctors usually only prescribe corticosteroid medications for a short amount of time to reduce symptoms, and then place patients on less dangerous regimens or over-the-counter drugs once symptoms are better controlled.

DMARDs, or disease-modifying antirheumatic drugs, are long-term medications meant to slow or alter the progression of rheumatoid arthritis by stopping the immune system from attacking healthy tissue. These drugs protect joints and tissues from permanent damage and gradually reduce daily pain. DMARDs can be taken with other pain relievers.

Examples of traditional DMARDs are:

• Methotrexate (Trexall)
• leflunomide (Arava)
• Hydroxychloroquine (Plaquenil)
• Sulfasalazine (Azulfidine)

Side effects are different for each patient and medication, but the most serious are liver damage and susceptibility to infections.

There is a subset of DMARD medications called biologic response modifiers. These drugs target specific parts of the immune system that trigger inflammation that causes joint damage. Blocking TNF inhibitors or the activation of T cells is one method of preventing the joint damage that frequently occurs in patients who suffer from RA. This greatly reduces the risk of further damage or infection. Biologic agents are typically prescribed in combination with other medications to fight RA symptoms.

Common biologic agents are:

• Abatacept (Orencia)
• Adalimumab (Humira)
• Anakinra (Kineret)
• Certolizumab (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade)
• Rituximab (Rituxan)
• Tocilizumab (Actemra)

JAK Inhibitors (such as Xeljanz) are another type of DMARDs that work against the pathways that increase the body’s immune response, known as Janus kinase. JAK inhibitors are helpful because they can be taken by mouth, unlike biologics, and they work well with traditional DMARDs. JAK inhibitors can dramatically decrease inflammation.

Physical Therapy

Keeping an active, healthy lifestyle is just as important in treating RA symptoms as the right combination of medications. Exercise may seem too painful, but low-risk exercises like walking and yoga can reduce inflammation. A physical therapist can help you design a safe, effective daily workout routine that will keep joints flexible.

Life with RA is difficult and not being physically able to complete certain routine tasks may lead to frustration. Physical therapists can help patients learn appropriate exercises and new ways of approaching tasks that minimize the strain on affected joints while improving overall body strength.

Chiropractic Treatment

Often, medication alone cannot alleviate all pain associated with RA. One approach to the chronic pain is seeking the care of a chiropractor. Some medical providers advise caution on chiropractic treatment due to the nature of the body manipulations that could potentially worsen RA pain. However, it has been found to be beneficial to certain RA patients. Patients should be cautioned not to receive care from chiropractors when active swelling or RA flare-ups occur, as this could worsen the condition. Make sure to speak with your primary doctor before pursuing any additional, specialized interventions such as chiropractic treatment.

Surgery

Surgery is not the standard of care in the treatment of RA. Surgical management is usually reserved for those with severe joint damage and should always occur in conjunction with the consultation of a rheumatologist. As mentioned before, RA is an inflammatory condition that ultimately leads to joint destruction and is a disease that can accelerate the natural course of joint damage that often occurs with aging. There is no cure, ability to restore damage or fix the deformities caused by RA. However, surgery potentially enables patients to regain function by repairing the joint damage that frequently occurs with this condition. The overall goal of surgery, when deemed appropriate, is to improve the quality of life of those affected.

There are three surgical procedures that RA patients typically receive. These are:

• Joint replacement — surgeons remove part of your damaged joint and insert a prosthetic (artificial) replacement
• Joint fusion — when replacements aren’t possible, surgeons can fuse and realign joints
• Tendon repair — over time, inflammation can damage tendons. Surgeons can fix these damaged tendons, to enable easier movement.

For more information on managing Rheumatoid Arthritis and improving symptoms, visit our Living with RA section.