Rheumatoid Arthritis (RA) Treatment

Treatment for rheumatoid arthritis typically involves a combination of medication and lifestyle changes, such as stopping smoking and getting enough exercise. Surgery is rarely recommended.

The goals of treatment are to:

• Control symptoms, such as pain and fatigue
• Prevent damage to joints and other tissues
• Improve joint function as well as overall health

When these goals are achieved, patients can work, participate in hobbies, and socialize with few interruptions or restrictions.

Start Treatment Early

Patients who are treated early on in their disease tend to do better than patients whose treatment is delayed. Research suggests treating RA within the first 2 years of symptom onset significantly reduces the risk of severe joint damage and disability.

To get newly diagnosed patients into RA remission, aggressive treatment may be needed, at least initially. Once remission has been achieved, some patients (working with their physicians) are able to reduce the number or dosage of medications.

Use the treat-to-target approach

The American College of Rheumatology recommends doctors and their patients use the treat-to-target approach. Using this approach, each person is treated with a specific goal in mind, either RA remission or lower disease activity. Progress toward the goal can be monitored using a specific test, such as Disease Activity Score (DAS) questionnaire or C-reactive protein (CRP) blood test.

Take Medications as Directed

People with rheumatoid arthritis typically take at least one medication. The medications used to treat rheumatoid arthritis fall into 5 main categories:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, meloxicam, and celecoxib
2. Corticosteroids, such as prednisone, methylprednisolone, and dexamethasone
3. Disease-modifying antirheumatic drugs (DMARDs), which are made to treat inflammatory arthritis, such as methotrexate, sulfasalazine, and hydroxychloroquine
4. Biologics that suppress immune system activity, such as adalimumab (Humera), etanercept (Enbrel), or infliximab (Remicade)
5. Janus kinase (JAK) inhibitors, the most recent category of drugs to be approved for RA treatment, includes tofacitinib citrate (Xeljanz) and upadacitinib (RINVOQ)

Initial treatment for rheumatoid arthritis typically includes methotrexate or another Disease-Modifying Antirheumatic Drug (DMARD). The medication can take several weeks or months to begin working, so a corticosteroid—usually prednisone—may also be temporarily prescribed to relieve symptoms.

Finding the right medication may be challenging. A medication may not work well enough or cause unwanted side effects that outweigh its benefits. In addition, a medication may stop working as well after months or years of taking it. In these cases, the dosage may have to be increased, a new medication may be added, or medication may be changed.

See 5 Types of Medication That Treat Rheumatoid Arthritis (RA)

Topical medications

Additional relief for joint pain may be found using topical creams, balms, gels, patches, and sprays. These medications can be applied to the skin over the painful joint and aim to either reduce or distract from pain.

Topical medications tend to have fewer side effects than medications taken orally, by injection, or by infusion. However, they can be absorbed through the skin, so side effects and drug interactions are still possible.

See Topical Pain Relief for Arthritis

Create Positive Lifestyle Habits

In addition to medication, several different lifestyle factors may influence rheumatoid disease activity. Healthy lifestyle habits can help decrease RA inflammation. These lifestyle habits include:

Staying physically active

Regular exercise can help decrease joint pain, build strength, and improve everyday living and overall health.¹Cooney JK, Law R-J, Matschke V, et al. Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research. 2011;2011:681640. doi:10.4061/2011/681640. Low-impact exercises, such as walking, swimming, and tai-chi, are frequently recommended for rheumatoid arthritis treatment.

See Exercising for Rheumatoid Arthritis Relief

Eating a healthy diet

Experts recommend avoiding foods that might promote inflammation, such as sugary sodas and processed meats, and eating a plant-based diet. A plant-based diet emphasizes whole grains and fresh fruits and vegetables but does not necessarily have to be vegan or vegetarian.

See The Ins and Outs of an Anti-Inflammatory Diet

Taking time to relax and reflect

Setting aside time to relax and reflect without distraction (what doctors may call mindfulness) can lower inflammation caused by stress hormones. Mindfulness strategies include but are not limited to meditating, deep breathing exercises, walking in nature, or writing in a journal.

Fostering healthy relationships

Take steps to foster healthy relationships and avoid so-called toxic relationships. While healthy relationships can have ups and downs, unhealthy relationships can cause extreme or constant stress that may contribute to inflammation.

Getting enough sleep

It can be tough to sleep with joint pain. Good sleep habits—what doctors call good sleep hygiene—may help improve sleep quality.

Avoiding nicotine and other toxins

Smoking, breathing polluted air (both indoors or outdoors), and consuming food or water contaminated with heavy metals expose the body to toxins. Toxins may contribute rheumatoid arthritis disease activity and may also decrease the effectiveness of RA medications.²Adami G, Viapiana O, Rossini M, et al. Association between environmental air pollution and rheumatoid arthritis flares. Rheumatology (Oxford). 2021;60(10):4591-4597. doi:10.1093/rheumatology/keab049^,3Ilar A, Alfredsson L, Wiebert P, Klareskog L, Bengtsson C. Occupation and Risk of Developing Rheumatoid Arthritis: Results From a Population-Based Case-Control Study. Arthritis Care Res (Hoboken). 2018;70(4):499-509. doi:10.1002/acr.23321^,4Irfan S, Rani A, Riaz N, Arshad M, Kashif Nawaz S. Comparative Evaluation of Heavy Metals in Patients with Rheumatoid Arthritis and Healthy Control in Pakistani Population. Iran J Public Health. 2017;46(5):626-633.^,5Joo SH, Lee J, Hutchinson D, Song YW. Prevalence of rheumatoid arthritis in relation to serum cadmium concentrations: cross-sectional study using Korean National Health and Nutrition Examination Survey (KNHANES) data. BMJ Open. 2019;9(1):e023233. Published 2019 Jan 3. doi:10.1136/bmjopen-2018-023233^,6Frangos T, Maret W. Zinc and Cadmium in the Aetiology and Pathogenesis of Osteoarthritis and Rheumatoid Arthritis. Nutrients. 2020;13(1):53. Published 2020 Dec 26. doi:10.3390/nu13010053^,7Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI. Smoking and rheumatoid arthritis. Int J Mol Sci. 2014;15(12):22279-22295. Published 2014 Dec 3. doi:10.3390/ijms151222279

It is possible that committing to just one healthy habit will help reduce RA disease activity. Combining two or more healthy habits will increase the chances of achieving noticeable differences in symptoms. Differences in disease activity and symptoms may be noticeable quickly, in a matter of days, or gradually, over several weeks or months.

Supplements

While strong research supports treating RA with medications and lifestyle changes, there is little scientific evidence either for or against supplements.

In general, people who want to try supplements are advised to buy reputable brands (with third party testing). Take a supplement for a few months before deciding if it works. It is also a good idea to check with doctor or pharmacist before starting a supplement to make sure there are no potential interactions with existing medications.

See Dietary Supplements for Treating Arthritis

Consider Surgery If It Is Recommended

Most people with rheumatoid arthritis are able to avoid surgery. Surgery may be recommended if RA has caused moderate to severe joint damage that affects day-to-day living. The goals of surgery are to reduce joint pain and improve joint function.

The most common surgeries to treat RA joint damage include:

• Joint replacement to replace the joint with artificial parts
• Arthrodesis to fuse the joint, making it stable but less mobile
• Synovectomy to remove inflamed tissue from the joint

Even if surgery is recommended, it is up to the patient to decide whether or not to have it. Patients are encouraged to talk to their surgeons about the possible benefits and risks related to surgery.

See Surgery for Rheumatoid Arthritis (RA)