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Treatments and drugs
By Mayo Clinic staff
There is no cure for rheumatoid arthritis. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage. Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.
Medications
Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs as your disease progresses.
- NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.
- Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, cataracts, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
- Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
- Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. Examples include azathioprine (Imuran, Azasan) and cyclosporine (Neoral, Sandimmune, Gengraf). These medications can increase your susceptibility to infection.
- TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia). Potential side effects include nausea, diarrhea, hair loss and an increased risk of serious infections.
- Other drugs. Several other rheumatoid arthritis drugs target a variety of processes involved with inflammation in your body. These drugs include anakinra (Kineret), abatacept (Orencia), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz). Side effects vary but may include itching, abdominal pain, headache, runny nose or sore throat.
Therapy
Your doctor may send you to a therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.
Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Tools such as buttonhooks can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.
Surgery
If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. Rheumatoid arthritis surgery may involve one or more of the following procedures:
- Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
- Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
- Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.
Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor.
- Handout on health: Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Accessed June 26, 2013.
- Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.mdconsult.com/books/about.do?about=true&eid=$eid&isbn=978-1-4557-0295-4&uniqId=398813857-1936. Accessed June 26, 2013.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed June 26, 2013.
- Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-6/0/1678/0.html. Accessed June 26, 2013.
- Venables PJ, et al. Diagnosis and differential diagnosis of rheumatoid arthritis. http://www.uptodate.com/home. Accessed June 26, 2013.
- Schur PH, et al. General principles of management of rheumatoid arthritis in adults. http://www.uptodate.com/home. Accessed June 26, 2013.
- Matteson EL (expert opinion). Mayo Clinic, Rochester, Minn. July 2, 2013.
- Schur PH, et al. Nonpharmacologic and preventive therapies of rheumatoid arthritis. http://www.uptodate.com/home. Accessed June 26, 2013.
- Rheumatoid arthritis and complementary health approaches. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/RA/getthefacts.htm. Accessed July 1, 2013.
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