If you have inflamed joints, you’ll know about the chronic pain that rheumatoid arthritis (RA) causes. For those living with the condition, RA means that the immune system attacks healthy tissues, often in the joints, leaving severe inflammation and pain in its wake. Thankfully, you’ve got options.
A quick guide to rheumatoid arthritis treatment
RA treatment is not a “one-size-fits-all” kinda thing. There are loads of options depending on your RA stage and age. No two people with RA live the same experience, so no two treatments are the same either.
Some forms of treatment are medically involved, like surgery, whereas others focus on lifestyle changes.
Plus, the ideal treatment depends on your goals, like:
- stopping or reducing inflammation
- relieving symptoms
- preventing joint and organ damage
- reducing long-term complications
- improving your daily function and well-being
The types of RA treatment include (and may combine):
- medication like nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologics
- surgical procedures like tendon repair, total joint replacement, and joint fusion
- lifestyle changes like following the Mediterranean diet, avoiding gluten when you eat, and exercising more
- home remedies like using hot and cold treatments or taking supplements
While RA hits differently based on its severity and when it began, there’s a boatload of treatments to help ease your symptoms and allow you to live life on your terms. Plus, various therapeutics are currently in the research stage. Even if you’re having trouble finding something suitable right now, there continue to be new meds on the horizon.
Let’s take a look at some standard RA treatments and the options making their way to center stage.
The ultimate goal of medication is to reduce inflammation or limit the progression of RA. The best one for you depends on your symptoms, the severity of your RA, and how long you’ve been living with the condition.
Annoyingly, RA can progress and cause permanent damage to your joints and other tissues. With that in mind, most RA meds work to slow down disease progression and prevent or reduce these potentially life-altering effects. And this is why it’s mega-important to begin treatment early and limit RA’s impact.
Some therapeutic options include:
- NSAIDs to reduce inflammation and ease pain
- corticosteroid pills, or injections to help your immune system chill TF out when it comes to attacking healthy tissue
- DMARDs and biologics to slow the course of RA progression by slowing the immune system’s overactivity
Watch out for the side effects of RA medication
All medications for RA can trigger unwanted and unpleasant side effects. It’s important to chat to the prescribing doc about the full potential impact of these drugs.
These might trigger:
- liver and kidney damage
- ringing in the ears
- heart issues
- stomach troubles (although NSAIDs are available that are a bit easier to take for folks with tummy probs)
These can cause side effects like:
- swollen legs
- weight gain
- higher blood pressure
- extreme mood shifts
Using corticosteroids over a longer period might lead to:
- increased blood sugar (or even full-on diabetes)
- a higher risk of infection
- weak bones (osteopenia or osteoporosis)
- skin that bruises easily
- higher risk of heart disease
As these affect the immune system directly, DMARDs may have different side effects for different people. The most severe adverse effects include liver damage and an increased risk of infections.
What are DMARDS, then?
DMARDs tackle RA symptoms by slowly changing and specifically dampening your body’s immune and inflammatory responses. They don’t provide immediate relief, but your symptoms should improve over weeks or months. Your doctor may recommend:
- biological DMARDs like adalimumab (Humira) and infliximab (Remicade), which reduce your immune system’s response to RA by reducing your count of inflammation-triggering T cells and blocking the substances that cause your body to enter inflammation mode
- nonbiological DMARDs like methotrexate (Trexall) and hydroxychloroquine (Plaquenil), which help slow down the effects of RA
- target synthetic DMARDs, which take aim at particular molecules called kinases that play a role in the inflammation pathway
You can use a combination of these meds, depending on your circumstances and your doc/healthcare pro’s recommendations.
Besides prescription medications, you can use various tips and tricks to ease RA symptoms at home.
Hot and cold treatments
When your RA is active, the affected joints can feel swollen and stiff, causing pain. Your muscles may begin to feel tired. If this sounds like you, heat treatments may ease these symptoms. Try a warm bath or a heating pad.
On the flip side, cold treatments can help with the common problem of swollen joints. When RA flares and inflammation increases, you may find that cold compresses help with the pain.
So, it might be that bag of frozen peas at the back of the freezer’s time to shine! Or, if you’re feeling fancy, pop a damp towel in a sealable plastic bag and leave it in the freezer for 15 minutes, then apply it to the area that’s uncomfortable.
However, check with your doctor before adding any new supplements to your daily routine, as they may affect or interact with the other medications you take.
You hear mention of specific diets for RA, and some people swear by various nutritional approaches. But there’s no specific diet that can ease RA symptoms.
A 2018 review of studies found mixed results when it came to the Mediterranean diet’s effect on RA symptoms.
In one study, a Mediterranean diet led to a reduction in disease activity, improvement in physical function, and increased vitality. Another reviewed study looked at the effect of a Mediterranean diet on a person’s risk of developing RA and found no significant association.
So, while a Mediterranean diet may help RA symptoms, it likely doesn’t decrease your risk of developing RA if you don’t already have it.
Another diet that’s often touted as valuable to people with RA is a gluten-free diet. The same review suggests it could benefit RA by reducing overly enthusiastic inflammatory responses. But the evidence doesn’t really reach a conclusion.
Still, if you find that a particular food or eating plan helps you feel better, don’t hold back! Likewise, if a particular form of chow makes your symptoms worse, try excluding it from your diet.
Many people with RA may find exercise challenging. But if you’re not getting enough exercise, your likelihood of developing related complications like hypertension, obesity, and type 2 diabetes heads skyward.
One of the most significant reasons for reduced life expectancy in folks with RA is cardiovascular or heart disease. So, if you’re living with RA, exercise can be super valuable for promoting heart health and keeping you well.
For peeps with RA, regular exercise can:
- increase muscle mass
- improve cardiorespiratory and cardiovascular health
- reduce the risk of obesity
- improve strength and physical function
- may reduce risk of flares
Also, consider that people living with RA might have cachexia, or a significant decrease in muscle mass. The weakened muscles then contribute to your risk of fatigue and diabetes.
Getting your sweat on regularly through high-intensity interval training (HIIT) can help you hang on to that muscle mass, according to a 2021 review. The studies included found that HIIT significantly boosted a person’s lean body mass and reduced the percentage of their body fat.
The “ouch” factor can make any form of exercise seem like an uphill struggle for folks with RA. But that’s where physical therapy comes in.
A physical therapist will sit down with you and work out a gentle, sustainable workout and stretching plan to keep yourself mobile and strong.
It’s not just useful for daily exercise either. Physical therapy can give you safe, comfortable workarounds that help with daily tasks like lifting, walking around, and getting out of chairs. It can help peeps who have RA retain a little more quality of life.
Should you try chiropractic treatment for pain relief if you have RA?
Medication might not cut it for RA pain relief, so some peeps give chiropractic treatment a go. But heavy caution: the manipulations risk making your symptoms worse, and are avoided for the neck.
It’s best to avoid chiropractic treatments if you’re experiencing an active flare-up of symptoms. Have a chat with your doc or healthcare pro if you’re considering complementary treatments like chiropractic manipulation.
Surgery is usually one of the last options that your doc will consider for managing your RA — and usually only after meds haven’t had the intended effect in slowing or preventing joint damage. As time’s gone on and medicines have improved, the need for surgery is rare.
The goal of surgery may be to restore your ability to use a joint, reduce pain, or improve function. A surgeon will recommend various surgeries based on their intended outcome, and they’ll factor your age, the severity of your symptoms, bone strength, and the location of RA into the decision.
A syno-what now? Well, the synovium is the joint lining, and it can become pretty painful during RA’s relentless inflammation. If anti-inflammatories aren’t hitting their mark, folks with inflamed joint linings have another option.
During a synovectomy, the surgeon removes the inflamed lining of the joint. The aim is to reduce your pain, improve the joint’s flexibility, and prevent bone and tissue damage.
Folks who undergo this surgery are often able to bring down their intake of anti-inflammatory medications. However, if your surgeon is recommending an open synovectomy, ask them about an arthroscopic — or keyhole — version of the procedure. It’s both less expensive and less risky.
Total joint replacement (TJR) or arthroplasty
For those with severe joint damage, a surgeon may give the green light for joint replacement surgery. (You know hip or knee replacement? They’re types of TJR.)
This involves removing the damaged part of the joint and replacing it with a prosthesis made of plastic and metal. This procedure has a good rep for safety and effectiveness and can improve a person with RA’s daily function and mobility.
However, just like the original joint, a TJR isn’t forever — the implant usually lasts 15 to 20 years. It might need replacing in another procedure called a joint revision further down the line, and that procedure is more expensive and often less successful than the original.
Also, it matters what the artificial joint is actually made from. Metal-on-metal joints are available, but they can release ions that can potentially cause bone damage. Plastic and ceramic components are also available — so remember to ask the surgeon about your implant’s track record and how long it’ll last.
A minimally invasive version of this procedure is also available, which has a quicker recovery time and less pain — and who doesn’t love that? But be warned: there’s a higher risk of complications, and it’s not an easy procedure, so pick yourself a surgeon with lots of experience in minimally invasive TJRs.
Joint fusion or arthrodesis
If a total joint replacement isn’t an option, surgeons could fuse the joint to stabilize or realign it, which decrease the pain. They’ll use a pin, plate, or rod to join bones in a wrist, finger, ankle, or spine. Over time, the bones grow back and lock that sh*t down.
Hopefully, this provides some pain relief and stability to the joint. Peeps with RA will feel the benefits on a lifelong basis, and a joint fusion can help people reconnect with high-impact exercise. Runners rejoice!
However, fusing a joint isn’t a 💯 fix — it can reduce how much your joint moves and flexes. And it changes how the joints in the area support your movement so might trigger inflammation and chronic pain in other areas. For this reason, if your doc recommends joint fusion for lower back pain, it’s best to consider gentler treatments.
Some peeps don’t get along well with the current lineup of RA treatments, and others might develop side effects from long-term usage of these drugs. And yes, if this applies to you, you can adopt further lifestyle changes that may help. But there’s little scientific backing to many of the claims, so it might not be the panacea you hoped for.
If this sounds familiar, you’ll likely be intrigued by current research. There are several brand-spankin’-new options and some that improve upon existing treatments.
One such promising treatment is stem cell therapy, specifically mesenchymal stem cells (MSCs). These cells can impact the immune system, which plays a significant role in inflammation.
As of 2020, nearly 100 studies in their preclinical stages showed encouraging trends for RA applications. These studies have documented that MSC therapy can significantly reduce RA onset and progression.
However, as with most treatments, MSCs are likely to be most effective when applied during the early stages of RA. Currently, there are no MSC therapies approved for use, and even if available the cost would be very high.
Another treatment still in the developmental stage is breathing micelles (BM). These “breathe in” nitric oxide, which your bod may overproduce if you have RA — so they essentially mop up the mess. In the process, they also calm your inflammatory response and (hopefully) take that pain and reduced mobility away.
These bad boys have been more effective than NSAIDs for RA treatment in some preclinical studies.
Future treatment direction
Future treatments primarily focus on improving existing medicines, specifically DMARDs.
Some of this research includes identifying a biomarker or a marker in the body that shows how well certain medications are working. This might help doctors to produce better therapeutic results — as may well be the case with Janus kinase inhibitors (JAKi).
From trials, JAKi drugs seem to be as safe and effective as biologic DMARDs, but at a way more accessible price point.
More work is needed on reducing or discontinuing medications in people with low-RA disease activity or remission.
Rheumatoid arthritis (RA) varies from person to person based on the age of onset and disease severity.
Different treatment options include medications, surgical procedures, lifestyle changes, and home remedies. You may find that a combination of these approaches is the best way to manage your symptoms. Smoking definitely should be avoided as it can trigger RA and increase disease severity.
Treatment for RA is continually expanding. Current studies are investigating using stem cells and breathing micelles to treat RA. In addition, research is working on ways to improve DMARDs and other existing medications that don’t work well for everyone with RA.
You should check with your doctor about finding the best treatment option for you. One thing’s for sure, though — the earlier your treatment starts, the better.