Banish the Pain of RA

Rheumatoid arthritis treatments explained

January 31, 2012 / Author:  / Reviewed by: Joseph V. Madia, MD

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So, your doctor says you have rheumatoid arthritis. You feel stiff and in pain, and even moving around the house is hard. Fortunately, there are many ways to deal with arthritis pain, but which one is best for you?

Sadly, there is no cure for rheumatoid arthritis. But that does not mean you have to suffer night and day through the pain. With all the treatment options available, most patients can get the relief they need.

Once you are diagnosed with rheumatoid arthritis, your doctor is likely to prescribe one or more drugs to fight your disease and its symptoms. However, drugs are not your only option. Many rheumatoid arthritis patients have found that physical therapy and exercise relieve their symptoms. Some patients even say that complementary and alternative medicine - such as dietary supplements and mind-body therapies - helps to reduce the pain.

Before you and your doctor settle on a treatment plan, it is best to know all the options at your disposal. While the amount of options may seem overwhelming, your doctor and rheumatologist (an expert on diseases like rheumatoid arthritis) can help you sift through your choices.

The following article gives you basic information on some of the most common therapies for rheumatoid arthritis.

Medications

There is a variety of drugs available to rheumatoid arthritis patients. Some of these drugs treat symptoms only, while others slow down the progression of the entire disease.

It is important to keep in mind that some rheumatoid arthritis drugs have serious side effects. Before you begin taking prescription or over-the-counter drugs, talk to your doctor about any past conditions or problems with medications.

Disease-modifying antirheumatic drugs (DMARDs)

Over time, rheumatoid arthritis can cause permanent damage to your joints and other tissues. To prevent this from happening, doctors are likely to prescribe disease-modifying antirheumatic drugs, or DMARDs.

Most rheumatoid arthritis drugs are designed to treat symptoms such as pain, swelling, and stiffness. DMARDs, on the other hand, slow down the progression of the disease itself. In other words, these drugs treat the underlying processes that lead to the failure of the immune system and rheumatoid arthritis.

In the past, rheumatoid arthritis patients generally started their treatment with drugs that mainly dealt with symptoms, eventually working their way towards DMARDs. However, that course of action may be too slow to prevent permanent damage.

Doctors and scientists now believe that early treatment of rheumatoid arthritis with DMARDs may be patients' best bet for stopping irreversible joint damage. Some studies have shown that early treatment may even put rheumatoid arthritis into remission.

Commonly used DMARDs include:

  • Arava (leflunomide)
  • Trexall (methotrexate)
  • Rheumatrex (methotrexate)
  • Plaquenil (hydroxychloroquine)
  • Azulfidine (sulfasalazine)
  • Dynacin (minocycline)
  • Minocin (minocycline)

Plaquenil and Azulfidine originally were designed to treat malaria. Typically, they are used in combination with drugs like Trexall and Rheumatrex.

DMARDs can cause some serious side effects, including liver damage, bone marrow suppression, and lung infection. While side effects vary from person to person, it may be wise to get frequent blood tests while taking DMARDs.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Most cases of rheumatoid arthritis are treated with drugs that address symptoms. Nonsteroidal anti-inflammatory drugs, or NSAIDs, are the most commonly used symptom-fighting drugs.

NSAIDs work to reduce pain and inflammation - the hallmarks of rheumatoid arthritis.

You probably have taken NSAIDs. In fact, it is possible you were already taking NSAIDs before you were diagnosed. They come in both over-the-counter and prescription forms.

Commonly used over-the-counter NSAIDs include:

  • Advil (ibuprofen)
  • Motrin (ibuprofen)
  • Aleve (naproxen)
  • Bayer (aspirin)
  • Bufferin (aspirin)

Commonly used prescription NSAIDs include:

  • Mobic (meloxicam)
  • Lodine (etodolac)
  • Relafen (nabumetone)
  • Clinoril (sulindac)
  • Celebrex (celecoxib)

NSAIDs come in many other forms sold under countless brand names. Ask your doctor about your choices of NSAIDs.

If you are taking NSAIDs, you may experience minor side effects such as stomach irritation and ear ringing. Serious side effects include liver damage, kidney damage, and heart problems.

Steroids

Your doctor may choose also to use steroids - or corticosteroids - in your treatment plan.

Examples of corticosteroids include:

  • Deltasone (prednisone)
  • Liquid Pred (prednisone)
  • Meticorten (prednisone)
  • Decadron (dexamethasone)
  • Medrol (methylprednisolone)

Like NSAIDs, corticosteroids address the symptoms of rheumatoid arthritis. They work well to reduce pain, swelling, and inflammation. However, they can cause serious and long-term side effects, including:

  • cataracts (clouding of the lenses in the eyes)
  • bone thinning
  • weight gain
  • diabetes

In light of these side effects, it is recommended that rheumatoid arthritis patients take corticosteroids only for short courses when needed.

TNF inhibitors

Tumor necrosis factor-alpha (TNF-alpha) is a substance made by the body that causes inflammation. TNF inhibitors block this substance, thus reducing inflammation.

Doctors prescribe TNF inhibitors to reduce joint pain, stiffness, tenderness, and swelling.

Examples of TNF inhibitors include:

  • Humira (adalimumab)
  • Enbrel (etanercept)
  • Remicade (infliximab)
  • Simponi (golimumab)
  • Cimzia (certolizumab)

TNF inhibitors can cause serious side effects, including a higher risk of infections, congestive heart failure, and some cancers.

Immunosuppressants

Rheumatoid arthritis is an autoimmune disease, meaning it occurs when the body's immune system mistakenly attacks healthy tissues. The job of immunosuppressants is to control this overactive immune system.

Examples of immunosuppressants include:

  • Imuran (azathioprine)
  • Azasan (azathioprine)
  • Neoral (cyclosporine)
  • Sandimmune (cyclosporine)
  • Gengraf (cyclosporine)
  • Cytoxan (cyclophosphamide)

Patients taking these drugs may become more prone to infections.

Other medications

There are other rheumatoid arthritis drugs that address the inflammatory processes of the body.

Examples of these drugs include:

  • Rituxan (rituximab)
  • Orencia (abatacept)
  • Kineret (anakinra)
  • Actemra (tocilizumab)

Physical Therapy and Exercise

At first, you may think that exercise is going to make your arthritis worse, but physical activity is actually a major part of arthritis treatment. As a matter of fact, your joints are likely to become even more painful and rigid if you do not exercise.

If you have rheumatoid arthritis, your exercises are designed primarily to relieve pain and stiffness. Some arthritis exercises may involve stretching while others build your muscles. Working with your doctor and a physical therapist, you can put together a well-rounded exercise program that can:

  • increase muscle around your joints
  • reduce pain and stiffness
  • increase joint function
  • increase bone strength
  • reduce fatigue
  • help you maintain a healthy body weight
  • improve sleep
  • improve your mood
  • increase your overall quality of life

Make sure you talk to your doctor or physical therapist before starting any physical activities. Not only can they give you guidance, but they also can help you avoid hurting yourself or making your symptoms worse.

All exercises for rheumatoid arthritis are cheap and easy. You just have to figure out which ones give you the most relief. Who knows, you may find that a little physical activity is pretty much all you need to keep the pain at bay.

Flexibility exercises

Both stretching and range-of-motion exercises help you maintain or improve your flexibility.

In range-of-motion exercises, you gently bend and extend your joints as far as they can comfortably go. These can be done 5 to 10 times a day in the comfort of your home or at work.

Stretching is another simple activity you can easily fit into your daily schedule.

Yoga is one activity that involves both stretching and range-of-motion exercises.

Strengthening exercises

Building the right muscles can take some of the stress off of painful joints while also giving them more support. Strengthening exercises will help you build these muscles. On top of that, they can reduce bone loss - a condition associated with rheumatoid arthritis, inactivity, and corticosteroid drugs.

Strengthening workouts often resistance exercises like raising a limb against gravity, lifting light weights, or pulling elastic bands. Moving through water may give some patients all the resistance they need.

Aerobic exercises

Rheumatoid arthritis can take a toll on your overall health and fitness. Aerobic exercises are made to counteract that.

Aerobic exercises can:

  • improve heart health
  • improve lung health
  • increase muscle function
  • help control weight
  • provide more energy
  • improve mood
  • improve sleep

Examples of aerobic exercises that are safe for rheumatoid arthritis patients include:

  • walking
  • aerobic dance
  • water exercises
  • bicycling
  • using equipment like treadmills and stationary bikes
Other exercises

No matter how slight, almost any movement can help. If you already do a certain workout, or have one in mind, ask your doctor if it is safe and works for your particular needs.

Surgery

Eventually, your doctor may recommend surgery if your medications failed to prevent or slow joint damage. Over time, rheumatoid arthritis may make your joints unusable. Surgery can repair these damaged joints.

Surgery for rheumatoid arthritis may involve procedures such as:

  • total joint replacement, in which the damaged joint is removed and replaced by an artificial joint
  • tendon repair, which may be needed if inflammation and joint damage caused your joints to loosen up or rupture
  • joint fusion, which is used stabilize a joint and relieve pain if joint replacement is not an option

Natural Treatments

If other treatments do not seem to be working, many rheumatoid arthritis patients turn to alternative and complementary medicine (CAM) - more commonly referred to as natural medicine.

Natural treatments are not a replacement for your prescribed medications, particularly because few natural treatments have been extensively researched. However, they may give you that extra boost you need to control your pain.

Talk to your doctor before adding any natural therapies to your treatment plan.

Dietary supplements

Both fish oils and plant oils have shown promise in the treatment of rheumatoid arthritis. Even so, much more research is needed before doctors and scientists can confirm the safety and effectiveness of these supplements.

Some limited research has shown that fish oil supplements may relieve the pain and stiffness caused by rheumatoid arthritis.

The seeds of some plants contain a substance that may relieve pain and morning stiffness in rheumatoid arthritis patients. These plants include evening primrose, borage, and black currant.

Talk to your doctor before using any of these supplements, as they can interfere with medications. Some plant oils can even cause liver damage.

Mind-body therapies

Your physical health has an impact on your mental health, and vice versa. For some rheumatoid arthritis patients, addressing their mental stress is a huge part of relieving their physical symptoms.

Some examples of mind-body exercises that may help rheumatoid arthritis patients include relaxation, imagery therapy, and biofeedback. A strategy called mindfulness-based stress reduction may also help patients battle the depression that so often accompanies rheumatoid arthritis.

A Team Effort

It may seem like a daunting task to figure out which treatments work best for you. But remember: you are not alone when it comes to your battle with rheumatoid arthritis. Work with your doctor and physical therapist. Reach out to your family and friends for support. They are all there to help you find relief and continue living a normal, pain-free life. 

Reviewed by: 
Review Date: 
January 27, 2012
Last Updated:
January 31, 2012