Rheumatoid Arthritis Treatment Overview
First steps to consider
- If you think you have rheumatoid arthritis (RA), you should see a healthcare provider to get a diagnosis and discuss a treatment plan.
- RA can be treated with lifestyle changes, medication, or surgery.
Go to the ER if you have any of the following symptoms, which may be signs of RA complications like infection or heart disease, or may be serious side effects of RA medications:
- High fever with a rash
- Chest pain
- Trouble breathing
- Severe and sudden stomach pain
- Sudden spine pain
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When to see a healthcare provider
You should see a healthcare provider if you have symptoms of rheumatoid arthritis (RA), which include warmth and redness of the joints and pain, swelling, and stiffness in the joints. RA is a progressive disease, so treating it early can slow or stop it from getting worse. RA can lead to serious complications, including disability, joint destruction, heart disease, and osteoporosis.
There is no one test that can confirm you have RA. Your doctor will likely go over your medical history, symptoms, and check your joints for redness, warmth, and swelling. They may order blood tests that can show “markers” of RA, like inflammation levels in the body. They may order imaging tests, like X-rays or an MRI, to look for signs of joint damage.
What to expect from your doctor visit
- Most people with RA take medication for it. The type of medication your doctor recommends is based on the severity of the disease, among other factors.
- Antiinflammatory medications (NSAIDs) relieve pain and help control inflammation. Examples include celecoxib (Celebrex) and nabumetone (Relafen).
- The disease-modifying antirheumatic drug (DMARD) methotrexate (Trexall) is often the first medication your doctor will prescribe to slow down early-stage RA.
- A newer class of DMARDs, called biologic agents or biologics, may be prescribed if conventional DMARDs aren’t effective. Examples include etanercept (Enbrel) and golimumab (Simponi).
- Janus kinase (JAK) inhibitors are prescribed if DMARDs and biologics aren’t working.
- Corticosteroids reduce pain and inflammation and can slow down joint damage. Steroids have serious side effects and are usually used temporarily, often while you’re waiting for other medications to work or if your symptoms flare up.
- Your doctor may suggest physical therapy to help you regain joint strength and mobility.
- Occupational therapy is helpful if RA is making it difficult to do everyday tasks, like household chores.
- If these medications do not slow joint damage, surgery may be needed to repair damaged joints. Procedures include joint replacement, joint fusion, tendon repair, and synovectomy (removal of the inflamed joint lining).
Prescription rheumatoid arthritis medications
- Antiinflammatories: celecoxib (Celebrex), ibuprofen (prescription strength), nabumetone (Relafen), naproxen (Naprosyn), naproxen sodium (Anaprox), piroxicam (Feldene)
- DMARDs: methotrexate (Trexall), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), leflunomide (Arava)
- Biologic agents: abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara), tocilizumab (Actemra)
- Janus kinase (JAK) inhibitors: tofacitinib (Xeljanz), baricitinib (Olumiant), upadacitinib (Rinvoq)
Types of rheumatoid arthritis providers
- A primary care provider can evaluate symptoms and refer you to a specialist if they think you may have RA.
- A rheumatologist specializes in treating inflammatory (rheumatic) diseases, and diagnoses and treats RA.
- A physical therapist can help increase your strength and range of motion.
- An occupational therapist can teach you easier ways to do everyday activities.
- If surgery is necessary, you’ll be referred to an orthopedic surgeon, who specializes in treating diseases of the musculoskeletal system.
Treating rheumatoid arthritis at home
Always see a healthcare provider—either your primary care provider or a rheumatologist—to get a diagnosis. Symptoms of rheumatoid arthritis (RA) include warmth and redness of the joints and pain, swelling, and stiffness in the joints.
In some cases, OTC medications, at-home care, and lifestyle changes can help symptoms.
Antiinflammatory drugs (NSAIDs), like ibuprofen (Motrin, Advil) or naproxen (Aleve), can help pain by reducing joint inflammation. It is important to check with a provider to make sure NSAIDs are safe for you to take, as they can cause stomach irritation and liver and kidney problems.
Tips for treating rheumatoid arthritis
- Apply heat or cold to inflamed joints to reduce pain, muscle spasms, and swelling.
- For minor joint pain, apply OTC pain-relieving lotions, gels, sprays or patches. Look for ones that contain numbing ingredients like capsaicin, salicylates, or menthol.
- Exercise regularly to strengthen your muscles and improve the range of motion of your joints. Choose low-impact exercises that won’t stress your joints, like swimming and biking.
- Try mind-body techniques like yoga or tai chi, which may help with pain and inflammation.
- Use assistive devices like braces and splints that stabilize and rest the joints. If walking is difficult, try using a cane or crutch.
- Try to get 8 hours of sleep every night. Poor sleep can increase pain levels and make it harder to move. Get better quality rest by following sleep hygiene tips, like keeping your bedroom dark and quiet, limiting screen time before bed, and avoiding caffeine, alcohol, and big meals late in the day.
- Lose weight if you’re overweight. Extra weight puts pressure on your joints.
- Quit smoking. It can worsen your symptoms and prevent remission.
- Learn relaxing techniques like meditation and deep breathing. They can help relieve stress, which is common in people with a chronic illness.
- Joining a support group for people with RA can also help reduce stress and make you feel less isolated. You may find it comforting to talk with other people who understand what you’re going through.
- Eat a balanced diet that’s rich in foods that fight inflammation. These include fruit, vegetables, whole grains (oatmeal, brown rice), and fish like salmon and tuna.
- Avoid saturated fat and sugar.
- Fish oil supplements may reduce inflammation. Ask your doctor if they’re safe for you to take.