Rheumatoid Arthritis: Treatment

The management of rheumatoid arthritis has dramatically improved over the past 25 years. Early recognition of the disease is essential to allow for early treatment. While there is no cure for RA, it can be managed.

The mainstay of treatment in rheumatoid arthritis consists of pain control and medication to prevent any further damage to the joints and the other organs. The treat-to-target is the most accepted treatment approach for people with RA, the goal being to reach the target of remission or low disease activity and thus to obtain the best outcome for the person with rheumatoid arthritis.

There are many medication options for people with rheumatoid arthritis. Anti-inflammatory medications, including non-steroidal anti-inflammatory drugs (such as ibuprofen) and corticosteroids (such as prednisone), are often helpful in relieving the pain associated with RA and improving joint swelling and stiffness.

Specific disease-modifying anti-rheumatic drugs (known as DMARDs) are the mainstay of rheumatoid arthritis treatment. Examples include methotrexate, sulfasalazine, azathioprine and leflunomide. These work by modifying the body's immune system and reducing the inflammation. If the remission or low disease activity is not attained, or if the person with RA has an extra-articular manifestation of RA, step up therapy is offered, with, most commonly, the addition of a biologic agent or small molecule to the DMARD. These newer medications target even more specific aspects of the immune system and include infliximab, etanercept, adalimumab, tocilizumab and tofacitinib. The list of new drugs available for patients with rheumatoid arthritis keeps growing.

Each DMARD and biologic agent has its own side effect and toxicity profile and often requires regular blood testing and clinical monitoring to ensure safety.

In addition to medical therapy for RA, many people benefit from physical therapy and rehabilitation. Under the guidance of rehabilitation therapists, people with RA often learn how to appropriately rest, exercise, strengthen and maintain joint and muscle function.