Treating Rheumatoid Arthritis: An Overview of Medications, Therapies, and Surgery
Introduction
Rheumatoid arthritis is the most common type of inflammatory arthritis, affecting over 1 million adults in the United States. It is caused by the immune system mistakenly attacking the joints, leading to swelling, stiffness, and pain. The small joints of the hands and feet are usually affected first, but larger joints can become involved as the disease progresses. Early diagnosis and treatment is important to prevent permanent joint damage. The goals of RA treatment are to reduce inflammation, relieve pain, prevent bone and cartilage destruction, and improve physical function.
Medications
Medications form the mainstay of rheumatoid arthritis treatment. They help control inflammation, ease pain, and slow disease progression. Common medications used for RA include:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs such as ibuprofen, naproxen, and celecoxib help relieve pain and reduce inflammation. They do not slow joint damage. NSAIDs may cause stomach upset, so proton pump inhibitors are often prescribed as well.
Corticosteroids
Corticosteroids like prednisone reduce inflammation and pain. They are often used as a "bridge" until other slower medications (like DMARDs) become effective. Long-term use can cause side effects.
Disease-Modifying Antirheumatic Drugs (DMARDs)
DMARDs slow the progression of rheumatoid arthritis by modifying the immune system's inflammatory response. Methotrexate is usually the first DMARD prescribed. Other options include leflunomide, hydroxychloroquine, and sulfasalazine. DMARDs can take weeks to months to become fully effective.
Biologic Agents
Biologics target specific parts of the immune system. Anti-TNF drugs like etanercept, adalimumab, and infliximab block TNF, an inflammation-causing protein. Other biologics work in different ways. Biologics are used for moderate to severe rheumatoid arthritis unresponsive to conventional DMARDs.
JAK Inhibitors
The newest class of RA drugs, JAK inhibitors such as tofacitinib work by blocking Janus kinases, enzymes involved in immune system signaling.
Lifestyle Changes and Alternative Therapies
Along with medications, making certain lifestyle changes can help manage RA symptoms. These include:
- Exercise: Low-impact aerobic exercise can reduce pain and improve joint mobility. However, avoid overdoing activities that stress swollen, tender joints.
- Diet: While no specific diet has been proven to treat RA, eating a balanced, anti-inflammatory diet with lots of fruits, vegetables, fish, and healthy fats may help some patients. Losing excess weight also reduces pressure on weight-bearing joints.
- Rest: Getting adequate rest allows the body to heal inflammation. Using splints or braces to support affected joints can also help.
- Heat/Cold Therapy: Applying hot or cold packs helps relieve joint pain and stiffness for some RA patients.
- Stress Reduction: Learning relaxation techniques to better cope with RA pain and fatigue may be beneficial. Counseling may also help manage the stress of living with a chronic condition.
Some patients try alternative therapies like acupuncture, massage, or supplements, but more research is needed on their efficacy and safety. Be sure to discuss any alternative treatments with your rheumatologist first.
Surgery
For patients with severe joint damage who do not respond sufficiently to medications and other therapies, orthopedic surgery may be an option. Common RA surgeries include:
- Synovectomy: Removal of the inflamed synovial membrane lining the joint. This can reduce inflammation and pain.
- Joint Fusion: Fusingtogether two bones across a damaged joint to improve stability and reduce pain. However, joint motion is sacrificed.
- Joint Replacement: Removing a damaged joint and replacing it with a metal, plastic, or ceramic prosthetic joint. Knee and hip replacements are most common.
Surgery can significantly improve mobility and quality of life for RA patients with advanced joint damage. The risks and benefits of each procedure should be carefully weighed.
Conclusion
While rheumatoid arthritis has no cure, starting treatment early is key to prevent disability. Medications, lifestyle changes, alternative therapies, and surgery when needed can help manage RA symptoms, relieve pain, and improve joint function. Treatment is highly customized to each patient's disease severity and response. With proper management, most people with rheumatoid arthritis can lead full, active lives. Continued research brings hope for even more effective therapies in the future.
References
Mayo Clinic. Rheumatoid Arthritis. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
Arthritis Foundation. Rheumatoid Arthritis Treatment.
Johns Hopkins Arthritis Center. Rheumatoid Arthritis Treatment. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
Cleveland Clinic. Rheumatoid Arthritis Treatment Options.
