What are the treatments for rheumatoid arthritis?
Rheumatoid Arthritis Treatment
Medication, physical therapy, and surgery are proven treatments for RA.
Rheumatoid arthritis, or RA, is a chronic inflammatory disease of the joints that affects about 1.35 million people in the United States, according to a report published in September 2019 in the journal Rheumatology International. (1)
There's no known cure for this condition. Treatment instead focuses on effectively stopping the progression of the disease in the following ways:
- Reducing symptoms and long-term complications, such as pain and joint swelling
- Getting joint inflammation under tight control or stopping it altogether (putting the disease in remission)
- Minimizing joint and organ damage
- Improving physical function and quality of life (2)
Achieving RA remission is a lot easier for people who don't have high disease activity — that is, people who don't have inflammation affecting numerous joints, evidence of bone erosion, rheumatoid nodules, or blood that's positive for certain inflammation-related antibodies, among other things. (3)
Drugs, physical therapy, and surgery are proven therapies for rheumatoid arthritis.
Medication for Treating Rheumatoid Arthritis
Early, aggressive treatment of RA can help control symptoms and complications before the disease significantly worsens by reducing or altogether stopping inflammation as quickly as possible. It is key to preventing disability.
This strategy essentially amounts to treatment with anti-inflammatory drugs, and sometimes by taking more than one medication at a time.
There are three main categories of medication for rheumatoid arthritis:
As their name implies, DMARDs can slow the progression of RA. Corticosteroids and NSAIDs, on the other hand, can help with acute pain and inflammation but do not stop or slow the progression of RA; though corticosteroids may help preserve function until DMARDs can start taking effect. (5)
Disease-Modifying Anti-Rheumatic Drugs for RA
Today, doctors may prescribe DMARDs very early in the course of the RA disease, sometimes right after a diagnosis is made, to try to prevent cartilage damage and bony erosions, which can develop within the first two years of the disease, according to the Johns Hopkins Arthritis Center.
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. It's important to note that all DMARDs become less effective over time.
A newer class of DMARDs, called biologics, are also available and work by targeting the specific steps in the inflammatory process. Created from living cells, biologics are usually used to treat moderate to severe RA, as well as patients who have not responded well to conventional DMARDs or other treatments. (6)
While past research suggested certain biologics increased a person's risk of developing lymphomas (cancer of the lymph nodes), more recent studies have suggested otherwise. The increased risk of lymphomas for RA patients likely has to do with RA-related inflammation.
Neither conventional nor biologic DMARDs are meant to be pain relievers, and both may take a few months to work, though some biologics can begin to work in as little as two weeks. (5)
Your doctor may prescribe corticosteroids and NSAIDs in the meantime to help with acute pain and inflammation.
Physical and Occupational Therapy for RA
Your doctor may prescribe physical and occupational therapy along with medication to help relieve pain and joint stress, reduce inflammation, and preserve joint structure and function. (5)
An occupational therapist can teach you how to modify your home and workplace and better navigate your surroundings to effectively reduce strain on your joints and prevent further aggravation of the inflammation during your day-to-day activities. Additionally, he can teach you how to perform regular tasks in different ways to better protect your joints.
He may also provide splints or braces that help support weakened and painful joints, and recommend devices to help you with daily tasks, such as bathing. (7)
A physical therapist can show you exercises to strengthen your muscles and keep your joints movable and flexible. Range-of-motion exercises, , and low-impact endurance exercises (walking, swimming, and cycling) all can help you preserve the function of your affected joints. (8)
She will 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.
She may also use hot or cold packs to temporarily reduce pain and stiffness in your joints. (5,6)
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 continued inflammation can cause carpal tunnel syndrome and loss of hand and finger functions.
Research published in July 2019 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 the participants' grip strength was lower than expected five years after diagnosis, even for people who were in remission or had limited disability. (9)
The results highlight the importance of hand exercises, particularly those that improve grip strength and finger range of motion, for RA patients. These exercises can include, among others:
- Opening and closing your hands repeatedly
- Pinching your fingers together (touching your thumb to the tips of your other fingers)
- Touch your thumb to the base of your other fingers
- Making a loose fist by drawing your fingers to the center of your palms
- Moving your wrists up and down
- Moving your hands in nice, easy circles
- Putting your hands flat on a table and raising your fingers up individually
These exercises, as your daily activities, should be interspersed with hand rests.
Joint Surgery For Treating Rheumatoid Arthritis: A Last Resort
For many people, medication and therapy are enough to keep RA under control.
Video: How Is Rheumatoid Arthritis Treated? - Manipal Hospitals
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