Prevention and Treatment

Unfortunately, there is no cure for RA. The key to maintaining a quality of life while living with RA is determined by the management of treatment. In order to reduce inflammation, relieve pain and improve function, the following treatment suggestions include:

  • Lifestyle modifications through proper and regular exercise
  • Medications
  • Surgery

Lifestyle

Exercise and learning how and what techniques to use becomes a vital skill for those with RA. Personalized exercises can be designed by a physical therapist to assist in maintaining muscle strength and flexibility without overusing joints. Swimming is ideal, as this exercise avoids stress being placed on joints. Splints are recommended in order to immobilize and support joints while resting. Cold or hot applications have assisted in palliative treatment measures used prior or after exercise therapy. Occupational therapists can provide helpful alternatives in reducing joint stress while performing daily activities with devices assisting in writing, lifting objects and eating.29

Medications

A broad range of medications have been FDA approved to treat RA. They vary in cost, effectiveness and side effects. Some physicians recommend supplements, yet little evidence is available to qualify their effectiveness. Some research studies indicate omega-3 fatty acids, those in plant seed oils and certain fish, can potentially reduce inflammation, yet the recommended dose for positive effects appears too difficult to tolerate. If supplements or herbal remedies are considered, the physician should be consulted as many medications can interact negatively.29

Medications fall into several categories, each requiring careful monitoring with periodic blood screening tests (Table 4). Analgesics and anti-inflammatory agents assist in relieving stiffness, pain and inflammation; however, they do not slow disease progression or prevent joint damage.29 Documented long-term effects from cortisone therapy have been determined undesirable; nevertheless, cortisone injections used adjunctively in treatment regimens have proven valuable.39

Table 4. Medications used for Rheumatoid Arthritis.29,35
MedicationsEffectsSide Effects
1. Analgesics & Anti-Inflammatory Agents:
Analgesic agents:Pain relief only, do not reduce inflammation
Acetaminophen (Tylenol)
Rx: Acetaminophen with codeine (Tylenol with codeine)

Acetaminophen with hydrocodone (Vicodin)
Anti-inflammatory agents:
Nonsteroidal anti-inflammatory drugs (NSAIDs)Can also act as analgesics, Aim to relieve pain, stiffness & inflammation, yet do not prevent joint damage or slow the disease progression
Aspirin, Aleve, Ibuprofen (Advil, Motrin)
Ketoprofen (Orudis)
Naproxen (Naprosyn)
Doclofenec (Voltaren)
Reduce swelling, upset stomach, easy to bruise, ulcers, kidney & liver damage increased risk of CVD
Newest of the (NSAIDs)
Cyclooxygenase-2 (Cox-2)
Celecoxib (Celebrex)
Stomach issues (indigestion, ulcers, bleeding at a lower rate than with other NSAIDS, increased risk of CVD
*All Rx (NSAIDs):
Including Celebrex carry a FDA warning regarding the risk of heart attack and stroke, and potential life-threatening stomach bleeding.
2. CorticosteroidsCan produce symptomatic benefits & have serious long-term consequences
Prednisone (Deltasone, Orasone)
Methylprednisolone (Medrol)
Suppress immune system & slow inflammation, produce dramatic improvement in short timeSerious long-term effects, osteoporosis, bruising, mood changes, weight gain, muscle weakness, diabetes, cataracts, increased chance of infection, hypertension
3. Disease-modifying antirheumatic drugs (DMARDs)Alter course of disease, prevent cartilage & joint destruction-may take weeks or months for effects
Injectable gold Oral sores, skin rash, kidney & stomach problems, low blood count
Antimalarials (Plaquenil) Eye problems, upset stomach
Sulfasalazine (Azulfidine) Upset stomach
Penicillamine (Cuprimine, Depen) Skin rashes, upset stomach, kidney problems, blood abnormalities
Etanercept (Enbrel) Etanercept-injection site reaction
4. Immunosuppressants*Are used for patients with systemic disease (all may cause birth defects)
Methotrexate (Rheumatrex)Suppress immune system, arrest inflammationLow white-cell count, potential liver problems
Azathioprine (Imuran) Low white-cell count, increased cancer risk, potential blood cell abnormalities
Cyclophosphamide (Cytoxan) Low white-cell count, increased cancer risk, other blood abnormalities
Leflunomide (Arava) Diarrhea, rash, hair loss, liver problems, cancer risk
5. Biological Response Modifiers (BMRs)
Etanercept (Enbrel)
Infliximab (Remicade)
Adalimumab (Humira)
Tumor necrosis factor alpha (TNFa) blockers [all begin working in 2 weeks may take up to 3 mos. for max. benefit]

Enbrel –injection weekly
Humira-injection every 2 weeks
Remicade-IV infusion every 2 months, after three initial injections
Anakinra (Kineret)Interleukin 1 (IL-1) blockerDaily injection, may take 4 weeks for benefits, 3 mos. for max. benefit
Abatacept (Orencia)T cell activation blocker(IV infusion every 2 weeks to start (first three infusions and every 4 weeks thereafter benefits begin in 2 weeks and may take 3 mos. for max benefit

Disease modifying anti-rheumatic drugs (DMARDs) are prescribed for altering the disease course while preventing joint and bone damage occurring from secondary inflammatory responses. They have been used separately or in combination with other medications with results reported as early as one month and up to six months from initial treatment. Early treatment with one effective DMARD, methotrexate, has shown favorable outcomes in RA years afterwards. Those prescribed with methotrexate continue with treatment regimens longer than other medications due to lessened side effects, effectiveness in controlling symptoms, and its ability to work in combination with biological agents. Immunosuppressant medications are used for those co-existing with systemic disease.35,38

The latest category of medications are biological response modifiers (BRMs) known as biologics, and are used to treat aggressive and debilitating cases when standard methods from one or more DMARDs have shown unfavorable responses. The BRMs target against cytokines triggering inflammation and approximately 70% of patients report improvement within the first two weeks from initial therapy. Their continued use is necessary in order to maintain results. When BRMs are combined with DMARDs, specifically methotrexate, greater efficacy has been indicated. BRMs exhibit few adverse reactions, unlike DMARDs yet side effects from long-term use remain unclear. BRMs are either injected or infused and mild skin irritations can occur at the injection site. Since BRMs suppress immune system functions, those individuals with active infections, including tuberculosis, or those prone to infection (e.g., diabetics) should be screened by their physician prior to treatment. Annual expenses for BRMs range from $17,000 to $25,000 with varying degrees of health insurance coverage.39