While there is no cure for rheumatoid arthritis, some patients can achieve remission when treated early with medications known as disease-modifying antirheumatic drugs (DMARDs), which can also help manage the disease to slow its progression and prevent joint damage.
In general, treatment for rheumatoid arthritis focuses on managing the disease by preserving mobility and function, pain reduction, and preventing joint damage, and includes other medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and biological agents.
Patients may additionally be prescribed physical therapy (PT) and/or occupational therapy and exercise, while some patients with more progressed rheumatoid arthritis may need surgery to repair or replace damaged joints, such as synovectomy (removal of joint lining), tendon repair, joint fusion, or total joint replacement.
Medications – The types of medications prescribed for rheumatoid arthritis depend on the symptoms, how far the disease has progressed, and include the following medications:
Non-steroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen (Advil or Motrin IB), naproxen sodium (Aleve), and celecoxib (Celebrex) may be used to relieve the pain and decrease inflammation associated with rheumatic arthritis. Other pain relievers, such as acetaminophen (Tylenol) or tramadol (Ultram), may also be used.
Steroids – Corticosteroids, such as prednisone, help decrease pain, inflammation, and slow joint damage.
Disease-modifying antirheumatic drugs (DMARDs) – These drugs can help prevent permanent joint and other tissue damage as well as can slow the progression of rheumatoid arthritis and include the medications methotrexate (Trexall and Otrexup), hydroxychloroquine (Plaquenil), leflunomide (Arava), and sulfasalazine (Azulfidine). Other types of disease-modifying antirheumatic drug known as Janus kinase (JAK inhibitors, such as tofacitinib (Xeljanz) or baractinib (Olumiant), may also be used.
Biologic agents – Biologic agents are a newer class of disease-modifying antirheumatic drugs (DMARDs) that target areas in the immune system that cause inflammation and joint and tissue damage, and are also known as biologic response modifiers, and include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret, certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara), and tocilizumab (Actemra).
Physical and/or Occupational Therapy and Exercise – A physical or occupational therapist can provide exercises and methods for daily living that can help preserve joint mobility, in addition to assistive devices, such as tools with large hand grips, to protect joints. Regular walking and low-impact exercises can also help decrease pressure on joints.
Surgery – Later stage rheumatoid arthritis that has progressed to severe joint damage or deformity may need surgery to repair or replace joints and/or to improve function and reduce pain. Surgeries for rheumatoid arthritis may include the following:
Synovectomy – This surgery removes the lining of joint (synovium) that is inflamed, such as on the fingers, wrists, elbows, and hips.
Tendon repair – Rheumatoid arthritis may cause tendon loosening or ruptures around joints and require tendon repair.
Joint fusion – Joint fusion is when a joint is made immobile via surgery to provide stability or realignment as well as pain relief.
Total joint replacement – Total joint replacement (arthroplasty) is when the damaged joint is removed and an implant (prosthesis) replaces the joint.
Splints, braces, slings, orthotics, or Ace bandages – Any of these can be worn to take the pressure off joints and protect them.