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Rheumatoid Arthritis: How Do I Manage?

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According to the National Institute of Health, treatments have come a long way from what they once were. At one point in time, treatments for the pain and dysfunction of RA were limited to aspirin, colloidal gold, and steroids. Although they relieved symptoms to some degree, steroids did not slow down the progress of the illness and had serious side-effects including hypertension, diabetes, osteoporosis and cataracts. Aspirin and gold had similar problems. Drugs such as methotrexate and cyclosporine were typically more effective, but also at times carried with them intolerable side-effects. Later treatment evolved to include non-steroidal anti-inflammatories, such as Naprosyn and Indocin, which could reduce the swelling and the pain, but did nothing to check the progression of the disease. During this period, patients with RA had a 10-20 year shortened life-span due to infection, premature atherosclerosis, and cancer. Today the treatment of this disease offers people with RA much hope for dramatically improved daily functioning. First, diagnosis to distinguish it from other inflammatory diseases has greatly improved with the identification of high-specific antibodies (proteins made by the immune system that are normally used to fight invading pathogens, such as bacteria and viruses), which, in RA and other types of auto-immune illnesses, mistakenly detect the body’s own tissue as foreign. Second, research in animal models of arthritis and on tissues from patients undergoing joint replacement, provided remarkable insight in to the disease process, and allowed for several molecules to targeted for novel drug development.

The biologics have made it possible to target certain parts of the rogue immune system, rather than shutting it down altogether. These drugs have brought a higher quality of life for many with RA and other types of inflammatory arthritis and with fewer side-effects than some of the earlier medications.

What about tomorrow? Presently there are ongoing NIH-funded studies to identify genetic variables in RA patients, which may affect responses to the growing number of RA treatments. These findings are already helping to match appropriate drugs for the management of individual patients. Researchers are hoping that by identifying certain types of genetic markers for RA in research subjects, they might one day develop therapeutic interventions before irreversible tissue damage occurs and would also allow for personalization of treatments. In addition, the identification and understanding of genetic, developmental, environmental, and other triggers that initiate disease in susceptible individuals will lead to preemptive strategies.

Treatments for RA In this section, you will find a list of the standard medical treatments for rheumatoid arthritis. Although these medications can often dramatically improve the daily functioning of people with RA, you should be aware that many of these drugs also have significant negative side-effects as well. It’s important that you find a competent physician to help you with your medical treatment. Many people find that it is beneficial to consult with an arthritis specialist (rheumatologist) to help you select which medication is best for you. These specialists, even more than general practice physicians, are trained to understand how these drugs work in your body and how to help you balance the benefits of the medication against the risks that come with them. They also know more about the non-joint symptoms to look for that might indicate an overlap condition.

  • Drugs That Relieve Symptoms: Non-Steroidal Anti-inflammatory Drugs (NSAIDS) or drugs used to ease pain and inflammation: e.g. ibuprofen (Advil/Motrin), ketoprofen (Frotek), and naproxen sodium (Aleve/Naprosyn), among others. For people with stomach ulcers, celecoxib (Celebrex), a COX-2 inhibitor, which is safer for the stomach.

  • Drugs That Slow Disease Activity: An example is corticosteroids, including prednisone, prednisolone, and methylprednisolone, which are potent and quick-acting anti-inflammatories. Because of the potential side effects of these drugs, they are used only for short-term treatment and in low doses as possible.

  • Drugs That Modify the Course of the Disease: Disease-Modifying Antirheumatic Drugs (DMARDS): e.g. methotrexate, hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), leflunomide (Arava), cyclophosphamide, and azathioprine (Imuran).

  • Biologics (A Subset of DMARDS): May act more quickly than DMARDS and are injected or given by infusion in the doctor’s office. Because they target specific steps in the inflammatory process, they don’t wipe out the entire immune response as other types of RA treatments do. e.g. etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade).

  • JAK Inhibitors (A Subset of DMARDS, which target the Janus Kinase (JAK) pathways, which are active in the immune response. E.g. tofacitinib (Xeljanz), which can be taken orally.

  • Surgery :An important option for people with permanent joint damage that limits daily functioning. This is called joint replacement.


  1. Arthritis Foundation, What is Rheumatoid Arthritis? (Arthritis Foundation, Retrieved, 8/3/2018)

  2. National Institute of Health, Rheumatoid Arthritis, Retrieved 8/4/18.

For more information on RA, click below:

This web site should not be used in lieu of getting professional medical care from a qualified physician. Although we are not doctors, we have done a bit of research on these issues from official and reliable sources and hope that we can provide some answers that can help you better understand this illness.

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