The joint pain, swelling, and stiffness brought on by rheumatoid arthritis can be extremely painful and disruptive to daily life. The amount of pain you feel with this inflammatory illness makes sense when you realize that the body is mistakenly attacking its own healthy cells, including the lining of your joints, as the Mayo Clinic explains. But with the right rheumatoid arthritis treatment, many people are able to find relief from this autoimmune disorder—some even reach a place where they barely notice their symptoms at all. Here’s information about rheumatoid arthritis treatments that might help you reach that goal.
What is the goal of rheumatoid arthritis treatment?
In treating rheumatoid arthritis, the American College of Rheumatology recommends a “treat-to-target” approach, where the physician frequently evaluates the patient’s disease status with the goal of getting them to a target of low disease activity or even remission, meaning extremely low or nonexistent disease activity. Basically, as few symptoms as possible.
In the past, rheumatoid arthritis treatment options were fairly limited, but now there are way more drugs to try, which often makes it easier to find something that’s effective, Namrata Singh, M.D., an assistant professor of medicine in the division of rheumatology at the University of Washington School of Medicine, tells SELF. If you or your doctor feel like one treatment isn’t working, there’s usually another option to try. “The sky’s the limit,” Dr. Singh says.
What are the options for rheumatoid arthritis treatment?
Here are some medications you might hear about when talking to your doctor about how to reduce your rheumatoid arthritis symptoms. Each specific medication has its own benefits, risks, and possible contraindications that will play into prescribing decisions, so make sure to ask your doctor if you have any questions about what life might be like on these different treatments or how they may affect your health overall. Also keep in mind that depending how severe your illness is or how you respond to various medications, your doctor may prescribe a combination of medicines to help you get as close to remission as possible.
Let’s start with the item on this list that you’re probably most familiar with. Nonsteroidal anti-inflammatory drugs, or NSAIDs, can help reduce pain and inflammation, according to the Mayo Clinic, which adds over-the-counter NSAIDs have stronger prescription counterparts. However, NSAIDs won’t actually slow or halt the progression of your rheumatoid arthritis like other options on this list might. NSAIDs are often an option for people looking for short-term relief when their symptoms flare, and most can move away from taking them when their symptoms are under control, says Dr. Singh.
The standard first-choice prescription treatment for people with early rheumatoid arthritis is a drug called methotrexate, according to the American College of Rheumatology. (Early rheumatoid arthritis is typically limited to the smaller joints, the Mayo Clinic explains, like the ones connecting your fingers to your hands and your toes to your feet.) Methotrexate is available both as a pill or an injection.
Methotrexate belongs to a class of medications called conventional disease-modifying antirheumatic drugs, or conventional DMARDs. Rather than simply reducing pain and inflammation like a nonsteroidal anti-inflammatory drug might, these are known to alter the progression of rheumatoid arthritis and reduce joint damage and disability, the American College of Rheumatology explains.
If you don’t respond to conventional DMARDs or experience a lot of side effects when you try them, your doctor may bring up a different type of medication called a biologic DMARD. Also known as biologics or biologic agents, these medications target the immune system more specifically to reduce inflammation and joint damage, the Mayo Clinic explains, and are delivered as a shot. TNF inhibitors are one type of biologic therapy commonly prescribed to rheumatoid arthritis patients; they work by countering the action of pro-inflammatory substances in the body.
“The interesting and cool thing about these biologic therapies is that usually they target one single molecule,” Kevin Byram, M.D., assistant professor of medicine in the division of rheumatology and immunology and associate director of the rheumatology training program at Vanderbilt University Medical Center, tells SELF. “They’re very targeted approaches.”
This level of targeting the inflammation can translate into better results when you use a biologic instead of a DMARD, according to the Cleveland Clinic, although sometimes doctors recommend using them together for the best results possible.
JAK inhibitors are a newer form of rheumatoid arthritis treatment that show a lot of promise, physicians say. They’re actually a type of DMARD that can be particularly helpful in people with moderate to severe rheumatoid arthritis, meaning it’s progressed past only affecting those smaller joints, and can also be a good option for people who haven’t had success with methotrexate. In fact, JAK inhibitors can be used in combination with methotrexate as a second-line treatment if methotrexate alone is ineffective, according to the American College of Rheumatology.
JAK stands for Janus kinase, a specific type of enzyme involved in bodily inflammation. By curbing this enzyme’s activity, JAK inhibitors can calm inflammation, pain, and prevent some of the joint damage associated with rheumatoid arthritis. Plus, JAK inhibitors are available in pill form, making them more appealing to many people who find shots intimidating. “I think everybody’s very excited about these medications,” Dr. Byram says.
Corticosteroids can offer quick relief for rheumatoid arthritis symptoms, according to the Mayo Clinic. These not only calm inflammation and related pain, but they can also slow down the joint damage that comes with rheumatoid arthritis. They’re often prescribed in conjunction with other rheumatoid arthritis drugs as a way of controlling pain and getting a person comfortable before the other drug kicks in, the Mayo Clinic says.
The trouble is, steroids come with a whole host of side effects, especially when taken over a long period of time. “The lowest dose possible for the shortest time possible should be the rule to treat with steroids,” Dr. Singh says. They also aren’t appropriate as a single therapy, according to Dr. Byram.
Talk to your doctor to find a rheumatoid arthritis treatment that works for you.
The goal of rheumatoid arthritis treatment is to get you to a place where you (and your joints) are as comfortable as possible. “We want to make [patients] feel as if they don’t have rheumatoid arthritis,” Dr. Singh says. But getting to a state of low disease activity or remission is a process that won’t look the same for everyone.
A lot of factors come into play when searching for a treatment that works, including the severity of your illness, the most up-to-date treatment recommendations from the American College of Rheumatology, your response to different medications, existing and potential side effects, and your insurance coverage.
Every case is a bit different, but physicians usually try to keep their patient on a rheumatoid arthritis medication for three months before moving on to something else—this gives them enough time to see if the medication is effective. “We want to give the drug three months before we say it’s a fail,” Dr. Singh says. “But it should kick in much earlier than three months.” However, if your condition is severe, your doctor may decide to change your medication (or add others) before that three-month mark.
Making decisions about your medication can be challenging, so communicating with your doctor is really important. In working toward a place of low disease activity, Dr. Byram says it’s important for doctors to frequently reevaluate how their patients are feeling and to involve them in treatment decisions, so remember that you’re not doing anything wrong by giving feedback or asking questions—you’re advocating for yourself and your health.
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