Treatment typically involves a combination of medication, exercise, diet, and lifestyle modification. The goals of treatment are to:
- Control symptoms, such as pain and fatigue
- Prevent damage to joints and other tissues
- Improve health and joint function, allowing patients to work and socialize
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Use the “Treat to Target” Philosophy
The American College of Rheumatology advises physicians to “treat to target,” meaning each patient should be treated with a specific goal in mind.
- For most people, the target is RA remission.
- In some cases, such as people who have tough-to-treat, longstanding RA, remission may not be possible, and the target may be to enter state of low disease activity.
Just as there is no single test to diagnose RA, there is no single test for RA remission. The “treat to target” recommendation simply encourages physicians to pick a measure and use it as a guide. For example, a physician may use:
- Disease activity score (DAS), a questionnaire that puts a numerical value on how many joints are tender and/or swollen (a score of 2.6 or lower indicates remission)
- C-reactive protein (CRP) blood test
- Erythrocyte sedimentation rate test (ESR) blood test
- Vectra DA, a relatively new test that measures 12 biomarkers associated with RA and combines results into a single score
Using these measures regularly, physicians can monitor patients and adjust treatment recommendations as needed to help meet the target.
Start Treatment Early
Almost all rheumatoid arthritis patients benefit from treatment, but patients who are treated within the first two years of symptom onset tend to do better than patients who receive treatment later. Early treatment reduces the risk of severe joint damage and disability.
To bring newly diagnosed patients into RA remission, aggressive treatment may be needed, at least initially. Once remission is achieved some patients (working with their physicians) are able to reduce the number or dosage of medications.
Take Prescription Medications as Directed
People with rheumatoid arthritis typically take at least one medication. The medications used to treat rheumatoid arthritis fall into five main categories:
- NSAIDs, such as naproxen (e.g. Aleve and Naprosyn), meloxicam (Mobic), and celecoxib ( Celebrex)
- Corticoteroids, primarily prednisone
- Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (e.g. Rheumatrex and Trexall)
- Biologics that suppress immune system activity, such as adalimumab (Humera), etanercept (Enbrel), or infliximab (Remicade).
- Janus kinase (JAK) inhibitors—this is the most recent category of drugs to be approved for RA treatment. In 2016, the FDA approved the JAK inhibitor tofacitinib citrate (XelJanz).
Initial treatment for rheumatoid arthritis typically includes a prescription for methotrexate or another DMARD. Medication can take several weeks or months to begin working, so a corticosteroid may also be temporarily prescribed to relieve symptoms.
If symptoms are not alleviated within a reasonable window of time, the doctor may recommend using methotrexate or another DMARD along with one other medication. Over months or years, a medication may become less effective or cause unacceptable side effects, and a new medication can be prescribed.
The importance of adhering to medication treatment recommendations
Some people may be tempted to skip taking medications because they have concerns about side effects or associated risks. Others may just forget to take the medication at the allotted time. Not taking a medication as directed will make it less effective.
Exercise and Maintain a Healthy Weight
Low-impact exercise such as walking, swimming, yoga, and tai-chi are frequently recommended for rheumatoid arthritis treatment. Regular exercise can decrease joint weakness28 and pain. Regular movement also helps achieve and maintain:
- Muscle strength
- Joint function and flexibility
- Sleep quality
- Healthy weight
- Cardiovascular health
Maintaining a healthy weight and cardiovascular health is particularly important to RA patients, who have an increased risk of heart disease. In addition, people with RA who maintain a healthy weight seem to have less pain and disease activity than patients who are overweight or obese.
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Eat a Healthy Diet
While the research is not totally clear, many experts believe there is a connection between diet and inflammation. They recommend an anti-inflammatory diet high in omega-3 fatty acids, such as fresh fruits and vegetables.
People who believe that the microbiome can influence RA recommend a diet high in vegetables as well as fruits and other whole foods that support gut health. Moreover, one small study found that people who took a probiotic for 8 weeks showed a decrease in inflammation.29
Whether or not eating certain foods can decrease RA symptoms is a controversial topic, but one idea is not up for debate: Eating a healthy diet is better for long-term health and reducing the risk of other diseases.
- Cooney JK, Law RJ, Matschke V, et al. Benefits of exercise in rheumatoid arthritis. J Aging Res. 2011;2011:681640.
- Vaghef-mehrabany E, Alipour B, Homayouni-rad A, Sharif SK, Asghari-jafarabadi M, Zavvari S. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition. 2014;30(4):430-5.