What are treatment options for rheumatoid arthritis?
There is no cure for rheumatoid arthritis; however, early intervention has been shown to be greatly beneficial for those suffering from rheumatoid arthritis to function almost to normal levels and remain in remission. The goal of treatment includes reducing inflammation, pain, and preventing permanent joint and other organ damage (eye, lung, nerves). Treatment options have evolved over the years. Although medications appear to be the most common method for the management of rheumatoid arthritis, TeleMed2U rheumatologists offer integrative, holistic treatment approaches as well, based upon a “S.E.N.S.E.” - ible approach: Stress management, Exercise, Nutrition, Sleep & positive social Engagements.
Here are the different types of medications currently available for rheumatoid arthritis:
- Disease-modifying antirheumatic drugs (DMARDs) - are the first-line treatments for rheumatoid arthritis as they positively influence the natural history of RA (makes RA less damaging to your joints and body). They are successful with treating symptoms and slowing the progression of joint damage from the disease. Examples include:
- methotrexate* (Rheumatrex, Trexall, Otrexup, Rasuvo)
- leflunomide (Arava)
- hydroxychloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
*If you are taking methotrexate, make sure you are also taking a folic acid supplement like MTX Advanced Support: https://theralogix.com/products/mtx-support-folic-acid-b12-supplement
- Nonsteroidal anti-inflammatory drugs (NSAIDs) - usually used in conjunction with DMARDs to help reduce pain and swelling from chronic inflammation. NSAIDS do NOT improve the natural history (outcome) of RA, but do help reduce pain.
- Corticosteroids - a stronger anti-inflammatory used alongside DMARDs as well that may help relieve symptoms. Usually used in a low dose form, and the goal of physicians is to eventually discontinue its use once symptoms have resolved. Cortisone does NOT improve the natural history (outcome) of RA, but does help to reduce pain, swelling and inflammation.
- Biologic response modifiers (biologic agents) - used for more advanced rheumatoid arthritis symptoms. These agents work by blocking the immune system’s signals to cause inflammation. They are usually combined with methotrexate to give a better treatment response, as only 20-25% of patients with moderate to severe RA are successfully managed with methotrexate alone. Examples of biologics include:
- abatacept (Orencia)
- adalimumab (Humira)
- anakinra (Kineret)
- certolizumab (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
- rituximab (Rituxan, MabThera)
- sarilumab (Kevzara)
- tocilizumab (Actemra)
- Targeted synthetic DMARDs - the newest class of medication for RA, usually used when traditional DMARDs and biologic agents have failed. Examples include:
- tofacitinib (Xeljanz)
- baracitinib (Olumiant)
- upadacitinib (Rinvoq)
If you have questions about RA treatments & pregnancy, please visit the Mother To Baby website at: https://mothertobaby.org/
If medications fail, what are other treatment options available?
Surgery may be considered for managing rheumatoid arthritis symptoms when medications fail to provide relief of symptoms or the joint has become severely damaged. The goal of surgery is to restore the function of the damaged joint and reduce pain. Some surgical procedures that may be considered include:
- Joint replacement - a prosthetic is usually inserted after damaged tissue and bone is removed from the joint.
- Joint fusion - a fusion of the joint is usually chosen when restoration of joint position is needed. It also provides pain relief and is performed if joint replacement surgery is not an option.
- Tendon repair - performed due to the chronic inflammation around the joint also affecting the tendons resulting in tears or ruptures.
- Synovectomy - involves removal of the inflamed synovium, which improves pain and flexibility of the joint.
Fortunately, since the development and proper use of biologic agents in the late 1990s, the need for joint surgery in RA patients have steadily declined.
Are there other treatment options available for rheumatoid arthritis other than medications or surgery?
Yes. It is believed that medication alone cannot tackle rheumatoid arthritis, and various self-management techniques may be helpful. Patient education and support is vital for understanding how to manage this condition. Therefore, a multidisciplinary approach with several different healthcare providers will be needed. A healthy diet, cessation of smoking, exercise, and even physical therapy may all be used as tactics to help reduce the symptoms that occur from rheumatoid arthritis.
Rheumatoid arthritis can be debilitating, however when an individualized, integrative treatment program is created with our physicians at TeleMed2U, you will be able to live your best life, managing your RA while taking the least amount of medications.