Rheumatoid Arthritis Treatment

There are numerous treatment options for patients with rheumatoid arthritis, and each program will differ based on the stage of the disease, severity of symptoms, and the patient’s own preferences. Regardless of the treatment protocol, the goals of treatment are always the same:

• Relieve pain and inflammation
• Slow the process of joint damage
• Help maintain or improve the patient’s ability to move and perform everyday tasks.

These goals can be achieved through lifestyle modification, exercise, medication, surgery, or – most often – through a combination of various therapies.

Exercise

One of the most important challenges for a rheumatoid arthritis patient is finding a balance between rest and exercise. This balance can shift depending on the stage of the disease: more rest is appropriate in periods of high disease activity while more exercise can be helpful when symptoms are relatively mild.

Exercise is an important part of any healthy lifestyle, but it becomes particularly crucial for patients with rheumatoid arthritis. Regular movement not only helps build muscle strength, but can also maintain mobility and flexibility in the affected joints. An exercise program can also provide additional benefits, such as fostering more restorative sleep, and naturally reducing the perception of pain through the release of endorphins, the body’s natural pain killer.

Lifestyle Modification

There are a variety of relatively minor changes that can improve life enjoyment for many patients with this condition. Here are a few examples:

• Splints that help to support the joints. Splints are most often used on hands or wrists and feet or ankles, and should be fitted by a doctor or occupational therapist. Using a splint for a short time can help support the joint and allow the pain and swelling to subside.
• There are also a number of tools and devices that can help relieve stress on the joints and make certain activities easier, such as long zipper pulls or long-handled grabbing tools.
• Patients can also change to products that are easier to manage, such as wearing slip-on shoes (vs. tying shoelaces), shirts with zippers (as opposed to buttons).

Traditional medications

Most patients who suffer from rheumatoid arthritis take some type of medication, but deciding which is appropriate for any individual situation can be difficult, and requires a process of trial and error to find the most effective approach depending on age, severity and on the patient’s other medical conditions.

Analgesics, such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (Advil), can be effectively employed to provide pain relief and reduce inflammation.

Steroids – low dose prednisone – are often prescribed at the time of diagnosis to relieve pain and decrease inflammation. Also, steroids can be injected into a joint if one or two joints are very painful or swollen. Steroids should not be taken for prolonged periods of time and should be used with other treatments.

A class of drugs, called disease-modifying antirheumatic drugs (DMARDs), are used to slow or stop the course of the disease. Some commonly used DMARDs include hydroxychloroquine, methotrexate, sulfasalazine, and azathioprine, among others.

Biologics

A new class of medications, called biologic response modifiers, is proving to be a promising type of drug treatment available for patients with rheumatoid arthritis. The medications are modified to selectively disrupt certain parts of the cascade of events that leads to inflammation, with the goal of reducing inflammation and damage to the joints. These medications can actually halt or stop the disease process. They are often used with the conventional DMARDs listed above. All biologics are given by intravenous (IV) or by shot (subcutaneous), not by mouth.

There are currently several biologic response modifiers approved for use in the treatment of rheumatoid arthritis, including:

• Etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), and adalimumab (Humira), which block the activity of tumor necrosis factor (TNF). TNF is an immune system protein that triggers inflammation during normal immune responses.
• Anakinra (Kineret), which blocks a cytokine (interleukin-1, or IL-1) that is often found in excess in rheumatoid arthritis patients.
• Rituximab (Rituxan) stops the activation of B cells, a type of white blood cell. Diminishing the activity of B cells reduces the activity of the immune system, which is typically overactive in patients with rheumatoid arthritis.
• Abatacept (Orencia) blocks a chemical that stimulates the overproduction of T cells, another type of white blood cell. T cells play a significant role in rheumatoid arthritis inflammation.
• Tocilizumab (Actemra) blocks IL-6 or interleukin-6, a chemical found in elevated levels in people with rheumatoid arthritis. It is currently only prescribed after at least one TNF medication was tried without satisfactory results.