Rheumatoid Arthritis: MedlinePlus Medical Encyclopedia

RA most often requires long-term treatment by an expert in arthritis called a rheumatologist. Treatment includes:

• Medicines
• Physical therapy
• Exercise
• Education to help you understand the nature of RA, your treatment options, and the need for regular follow-up
• Surgery, if required

Early treatment for RA with medicines called disease-modifying antirheumatic drugs (DMARDs) should be used in all patients. This will slow joint destruction and prevent deformities. The activity of the RA should be checked at regular visits to make sure the disease is under control. The goal of treatment is to stop the progression of the RA.

MEDICINES

Anti-inflammatory medicines: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib.

• These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible.
• Since they do not prevent joint damage if used alone, DMARDs should be used as well.

Disease modifying antirheumatic drugs (DMARDs): These are often the medicines that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs.

• Methotrexate is the most commonly used DMARD for RA. Leflunomide and hydroxychloroquine may also be used.
• Sulfasalazine is a medicine that is often combined with methotrexate and hydroxychloroquine (triple therapy).
• It may be weeks or months before you see any benefit from these medicines.
• These medicines may have serious side effects, so you will need frequent blood tests and other monitoring when taking them.
• Antimalarial medicines -- This group of medicines includes hydroxychloroquine (Plaquenil). They are most often used along with methotrexate. It may be weeks or months before you see any benefit from these medicines.

Corticosteroids -- These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects and do not prevent joint damage if used alone. Therefore, they should be taken only for a short time and in low doses when possible.

Biologic DMARD agents -- These medicines are designed to affect parts of the immune system that play a role in the disease process of RA.

• They may be given when other medicines, usually methotrexate, have not worked. Biologic medicines are often added to methotrexate. However, because they are very expensive, insurance approval is generally required.
• Most of them are given either under the skin or into a vein. There are now many different types of biologic agents.

Biologic and synthetic agents can be very helpful in treating RA. However, people taking these medicines must be watched closely because of uncommon, but serious adverse reactions:

• Infections from bacteria, viruses, and fungi
• Skin cancer, but not melanoma
• Skin reactions
• Allergic reactions
• Worsened heart failure
• Damage to nerves
• Low white blood cell count

SURGERY

Surgery may be needed to correct severely damaged joints. Surgery may include:

• Removal of the joint lining (synovectomy)
• Total joint replacement, in extreme cases, may include total knee replacement or total hip replacement.

PHYSICAL THERAPY

Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.

Sometimes, therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.

Other therapies that may help ease joint pain include:

• Joint protection techniques
• Heat and cold treatments
• Splints or orthotic devices to support and align joints
• Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night

NUTRITION

Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eat foods rich in fish oils (omega-3 fatty acids). Smoking cigarettes should be stopped. Excessive alcohol should also be avoided.