Rheumatoid Arthritis Guide
Arthritis of the Knee
Arthritis of the Shoulder
Arthritis of the Hands
|How Is Rheumatoid Arthritis Treated?
Currently there is no cure for rheumatoid arthritis (RA). The aim of any therapy will be to control symptoms and ideally halt the progression of the disease. A treatment plan is likely to include drug therapy, lifestyle changes, occupational and physical therapy and in severe cases, surgery. Alternative treatments like acupuncture are being increasingly recommended as part of an overall treatment plan. No single drug or treatment plan suits all, nor may one plan suit the same patient all of the time. Decisions about specific treatments should be discussed with a rheumatologist, a consultant doctor who specializes in the treatment of RA.
In the past, most patients were started off with corticosteroid painkillers/non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin. Then as the disease progressed they were slowly prescribed stronger medications called non-biologic disease-modifying antirheumatic drugs (DMARDs). DMARDS help to slow down the progression of the disease and delay joint damage. One of these medications, methotrexate (a drug initially designed to treat cancer) is considered the gold standard of RA treatment. And finally, if DMARDS failed to work, the patient would progress to biologic DMARDs (also called biologic drugs). These include several types of medications that block tumor necrosis factor (TNF), an immune system signaling molecule. Anti-TNFs (such as Enbrel, Remicade, Humira, Simponi, Cimzia) are effective, but they are expensive and can have severe side effects.
Today, a more aggressive treatment approach is recommended than in the past. People who receive a diagnosis of rheumatoid arthritis are moved from NSAIDs to non-biologic DMARDs much quicker (within 3 months) to halt the progress of the disease. The 2008 American College of Rheumatology also recommends that nonbiologic and biologic drugs should be accompanied by non-medical interventions including occupational and physical therapy as well as antiinflammatory drugs such as NSAIDs and oral glucocorticoids (steroids). See rheumatoid arthritis medications for more details.
In managing your disease it can be useful to work with various healthcare specialists. These include:
Physiatrist: A type of doctor with expertise in how bone, muscle and nerves work. They treat illnesses that affect how a person moves.
Physical therapist: Will give you an exercise plan to help keep your joints supple and to manage pain. The challenge is usually to find the balance between doing enough exercise to keep your joints moving, but not so much that it increases inflammation and pain. Generally exercise should be minimized during a flare up and increased during times of remission.
Occupational therapist: Evaluates your life, home and work environment and makes recommendations on how to make everyday tasks easier to perform. They will discuss suitable arthritis aids for your needs.
Orthopedist or orthotics technician: Help correct bone and joint deformities. They may prescribe splints or orthotic devices to support and align damaged joints.
If drug treatments fail to improve symptoms of rheumatoid arthritis, or fail to prevent joint damage, your doctor may recommend joint surgery. This is called orthopedic surgery and it is performed by an orthopedic surgeon. Common surgeries include:
Synovectomy: Usually performed in the early stages of RA, a synovectomy involves removing part of the inflamed synovial membrane (the lining of the joint) in the hand, wrist or knee. The surgical procedure used is called arthroscopy. If the patient is suffering from carpal tunnel syndrome in the hand, a ligament may also be cut to free trapped nerves.
Joint Fusion (arthrodesis): Painful joint is surgically removed and remaining 2 bones are fused together with screws and/or special brackets.
Total Joint Replacement (arthroplasty): Damaged joint is partly or completely replaced with an artificial metal or plastic joint called a prosthesis.
Despite all the hype about the benefits of supplements relieving RA pain, there is still very little evidence to show that they do. Some studies show fish oil supplements modestly improve symptoms, but only if taken in large enough quantities to cause side effects. Newer cartilage supplements like hyaluronic acids and chondroitin sulfate have been shown to reduce pain in those with osteoarthritis, but there is little evidence for their effectiveness in RA patients. Despite the lack of evidence, some people with RA have turned to herbal remedies and high doses of vitamins in the hope of some pain respite.
Various heat treatments can help relieve joint pain and massage can relieve muscle pain. Acupuncture, meditation and hydrotherapy may also be beneficial. See natural treatment for arthritis, for more details.
Sleeping for 8 to 10 hours per night is recommended.
Finally and most important of all, you don’t have to give up the life you had before you were diagnosed. You may have to put an action plan in place to help yourself. It’s no surprise that those who take regular exercise, eat healthy meals and lose weight are the most successful in managing their condition. Take care of yourself and monitor your lifestyle regularly.