Treatment and Prevention
Rheumatoid arthritis (RA) can't be prevented or cured. However, it is possible to treat the symptoms and, with certain medications, to slow down the progress of the disease - sometimes to a very significant degree.
A key factor, developed from careful studies over time, is to start treatment very early on before joint damage has occurred. If successful, this strategy can preserve joint health, something not often accomplished in the past.
Diagnosis, treatment, and management of RA require very experienced and skilled care by doctors who are very familiar with RA therapy. Rheumatologists specialize in severe arthritis such as RA. Before starting any medication, it is important to discuss the risks and benefits with your doctor.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for reducing pain and reducing inflammation of the joints, but they do not slow the progression of the disease. Examples of NSAIDs include ibuprofen*, meloxicam, and naproxen. The side effects of NSAIDs - including upset stomach or ulcers - can be minimized by other medications. Ask your doctor about these medications if you feel you need them. Some NSAIDs cause less stomach upset than others. If you find you can't tolerate the NSAID you are taking, talk to your doctor.
Corticosteroids (e.g., prednisone, triamcinolone) are also effective medications for reducing inflammation and relieving pain and stiffness. They can be taken as pills or injected directly into the joints. They are used sparingly and as little as possible because they don't actually slow down the damage done by RA. When corticosteroids are used for a long period of time, side effects include thinning of the skin and bones (increasing the risk of osteoporosis), high blood pressure and blood sugar levels, fluid retention, weight gain, muscle weakness, hip and shoulder damage, and lowered immunity against serious infection.
Disease-modifying antirheumatic drugs (DMARDs) can slow the disease and prevent joint damage. Hydroxychloroquine, methotrexate, and sulfasalazine require time (weeks to months) to work; they are important in combating the autoimmune component of RA. Other DMARDs, such as azathioprine, are available but they are used less often. DMARDs slow the damage by fighting immune system cells that attack the joints. These medications can be taken together with NSAIDs for inflammation and pain.
All these medications have potential serious side effects. They must be used very carefully, monitored closely, and some require special strategies.
Most doctors will recommend starting with hydroxychloroquine and methotrexate and will monitor how well the medications work for 1 to 2 months. If the response is very good, the medications are maintained. However, while many people with lupus do see an improvement in symptoms, they often do not improve enough.
Another group of medications is called biologics or biologic response modifiers. Examples of these medications include abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab. They are usually added to treatment with hydroxychloroquine and methotrexate. When they work fully, they improve physical symptoms and slow down or stop joint destruction. They also have their own sets of potentially serious, even life-threatening side effects. It is very important that you discuss the benefits and risks of all these treatments with your doctor.
Physical therapy and orthopedic intervention are often important in the management of the disease.
In spite of good medical treatment and lifestyle changes, RA may progress, increasing damage to your joints. When there is advanced disease or strong pain, surgery may be required to restore more regular movement. Surgery may help lessen pain, improve movement and function of joints, and, in some circumstances, improve physical appearance.
There are certain daily lifestyle adjustments you can make to help cope with RA:
- Apply cold packs to numb a sore joint and reduce inflammation.
- Use hot compresses to reduce pain and stiffness by relaxing muscles and increasing circulation.
- Seek physical therapy - a health care professional can help you manage pain, and teach you ways to strengthen muscles and restore motion in your joints. Low-impact exercises such as swimming and walking may also help prevent flare-ups.
- Protect your joints by learning which positions are less stressful on your joints when doing various activities. Pace yourself, and use canes, bath bars, shower seats, and reaching aids to make daily tasks easier.
- Follow a healthy diet and lifestyle and maintain a normal weight. Excess body mass is a "mechanical stress" on the joints, especially the hips and knees.
- Do not smoke.
For many people, having an effective treatment and management plan can restore their quality of life. It is important to learn all you can about your condition and the treatments that are available to you, and to work closely with your rheumatologist and the rest of your health care team. The Arthritis Foundation and the American College of Rheumatology are valuable resources.
Learning to manage RA will give you a feeling of control over the disease. With medical and lifestyle intervention, it's often possible to remain active and productive in all aspects of daily life.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Michael E. Makover, MD, is a professor of medicine at NYU School of Medicine and an Adjunct Professor at NYU College of Arts and Sciences. He is in the private practice of Rheumatology, Internal Medicine and Preventive Medicine in New York, NY. Review provided by VeriMed Healthcare Network.