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Rheumatoid Arthritis Treatment Options: Medications, Surgery, and More

Rheumatoid Arthritis Treatment

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Pain, stiffness, and decreased mobility are all symptoms of rheumatoid arthritis, a chronic inflammatory illness that causes inflammation of the joints. It affects people of all ages, although women and those over 40 are most vulnerable. Rheumatoid arthritis can be controlled with various medications, but there is yet no cure. In this post, we'll take a look at all of your options and help you pick the one that's best for you.

Medications for Rheumatoid Arthritis

Rheumatoid arthritis can be treated with a number of different pharmaceutical options. Medication therapy seeks to lessen inflammation, alleviate pain, and stop joint damage before it occurs. The following are examples of widely prescribed drugs:

Disease-modifying antirheumatic drugs (DMARDs) are medications that work to slow down or halt the progression of rheumatoid arthritis. The most commonly prescribed DMARD is methotrexate, which can be taken orally or by injection. Other DMARDs include leflunomide, hydroxychloroquine, and sulfasalazine. These medications can take several weeks or months to start working, and may have side effects such as nausea, vomiting, and liver damage.

Biologics are a newer class of medications that target specific parts of the immune system that contribute to inflammation. There are several types of biologics, including tumor necrosis factor (TNF) inhibitors, interleukin-6 (IL-6) inhibitors, and T-cell activation inhibitors. Biologics are usually given by injection or infusion, and may have side effects such as increased risk of infections.

Janus kinase (JAK) inhibitors are another newer class of medications that target a specific pathway in the immune system. These medications are taken orally and may have side effects such as headaches and increased risk of infections.

Corticosteroids are medications that work to reduce inflammation and relieve pain. They are often used in combination with other medications and are usually taken orally or by injection. Corticosteroids can have side effects such as weight gain, increased blood sugar levels, and increased risk of infections.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that work to reduce inflammation and relieve pain. They are available over-the-counter or by prescription and can be taken orally or topically. NSAIDs can have side effects such as stomach ulcers, kidney damage, and increased risk of heart attacks and strokes.

Early, aggressive treatment of rheumatoid arthritis can help prevent joint damage and disability. The goal of treatment is to achieve remission or low disease activity and to improve quality of life for the patient.

Dr. John Davis, Mayo Clinic College of Medicine

Surgical Options for Rheumatoid Arthritis

In some cases, surgical intervention may be necessary to manage rheumatoid arthritis. The following are some of the surgical options available:

Joint replacement surgery involves removing damaged or arthritic joints and replacing them with artificial ones. This procedure is most commonly performed on the hip and knee joints, but can also be done on other joints such as the shoulder, elbow, and ankle. Joint replacement surgery can significantly reduce pain and improve mobility, but does carry risks such as infection, blood clots, and implant failure.

Synovectomy is a surgical procedure that involves removing the lining of the joint (synovium) that is inflamed and causing pain. This procedure is most commonly done on the knee joint, but can also be done on other joints such as the wrist and elbow. Synovectomy can reduce pain and prevent further joint damage, but may not be a permanent solution.

Tendon repair is a surgical procedure that involves repairing tendons that have been damaged by rheumatoid arthritis. This procedure is most commonly done on the hands and feet, but can also be done on other joints such as the shoulder and knee. Tendon repair can improve mobility and reduce pain, but may not be a permanent solution.

Joint fusion is a surgical procedure that involves permanently fusing two bones together in a joint. This procedure is most commonly done on the wrist and ankle joints, but can also be done on other joints such as the shoulder and spine. Joint fusion can reduce pain and prevent further joint damage, but may result in reduced mobility.

Arthritis and Joint Supplements

If you live with Arthritis or joint pain, make sure you read our expert reviews and recommendations of the best supplements for joint pain. Supplements can improve joint health and reduce the symptoms and pain from Arthritis.

Reduction of Joint Stress

Rheumatoid arthritis treatment options include medication and surgery, but there are also lifestyle adjustments that can alleviate joint tension and lessen the severity of symptoms. Some approaches that have been useful include:

Physical therapy is a type of exercise program that is designed to improve strength, flexibility, and mobility. Physical therapy can help reduce pain and improve joint function, and may also help prevent further joint damage. A physical therapist can create a customized exercise program based on individual needs and abilities.

Weight management is important for people with rheumatoid arthritis, as excess weight can put additional stress on the joints. Maintaining a healthy weight through diet and exercise can help reduce pain and improve joint function.

Stress reduction techniques such as meditation, yoga, and deep breathing exercises can help reduce stress and manage symptoms of rheumatoid arthritis. Stress can exacerbate inflammation and pain, so finding ways to manage stress can be beneficial.

Assistive devices such as braces, splints, and orthotics can help support joints and reduce pain. These devices can also help improve mobility and prevent further joint damage.

Alternative and Complementary Therapies for Rheumatoid Arthritis

Alternative and complementary therapies are often used in conjunction with conventional treatments for rheumatoid arthritis. These therapies aim to manage pain and inflammation and improve overall well-being. Some alternative therapies that have shown promise in managing rheumatoid arthritis symptoms include:

Acupuncture is a traditional Chinese therapy that involves inserting thin needles into specific points on the body. Needling may help reduce pain and inflammation and improve joint function.

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Massage therapy can help reduce pain and stiffness in muscles and joints. It can also improve circulation and promote relaxation.

Yoga is a form of exercise that involves stretching, breathing, and relaxation techniques. Yoga can help improve flexibility, strength, and balance, and may also reduce stress and pain.

Meditation is a practice that involves focusing the mind on a specific thought, object, or activity. It can help reduce stress and improve overall well-being.

Tai Chi is a Chinese martial art that involves slow, gentle movements and deep breathing. Tai Chi can help improve flexibility, balance, and muscle strength, and may also reduce pain and improve joint function.

Dietary supplements such as fish oil, turmeric, and ginger may have anti-inflammatory properties and may help reduce pain and inflammation in people with rheumatoid arthritis. However, it is important to talk to a healthcare provider before taking any dietary supplements, as they may interact with other medications or have adverse side effects.

Managing Rheumatoid Arthritis in Children

Rheumatoid arthritis (RA) can also affect children, and managing the condition in children requires a different approach than in adults. Here are some effective strategies for managing RA in children:

Medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic agents, can help reduce pain, inflammation, and joint damage in children with RA. However, it is important to work with a healthcare provider to determine the most appropriate medication and dosage for each child, as some medications may have adverse side effects.

Physical therapy can help improve joint function, mobility, and muscle strength in children with RA. Physical therapists can develop individualized exercise programs and provide education on how to properly perform exercises to reduce pain and prevent further joint damage.

Occupational therapy can help children with RA perform daily activities such as dressing, grooming, and schoolwork. Occupational therapists can provide adaptive devices and equipment to make these tasks easier and less painful for children with RA.

Assistive devices such as braces, splints, and crutches can help support joints and reduce pain and inflammation in children with RA.

Emotional support is important for children with RA, as the condition can have a significant impact on their quality of life. Support groups, counseling, and other resources can help children and their families cope with the emotional and social challenges of living with RA.

Challenges of Rheumatoid Arthritis Treatment

While there are various treatments available for rheumatoid arthritis (RA), there are also several challenges that can make managing the condition difficult. Here are some common challenges of RA treatment:

Non-adherence to treatment can be a significant challenge in managing RA. Many people with RA may find it difficult to stick to a treatment plan due to factors such as forgetfulness, side effects, or inconvenience. However, non-adherence can lead to worsened symptoms and joint damage over time.

Side effects of medications are a common concern for people with RA. While medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologics can be effective in reducing pain and inflammation, they can also cause side effects such as nausea, fatigue, and increased risk of infection.

Cost of treatment can be a significant barrier to accessing effective RA care. Many RA medications and treatments can be expensive, and the cost of healthcare can be a burden for people without adequate insurance coverage.

Lack of access to healthcare can also be a challenge in managing RA. People living in rural or remote areas, or those who do not have access to specialized healthcare providers, may find it difficult to receive appropriate RA care.

Limited treatment options can also be a challenge for people with RA. While there are various treatments available, not all treatments are effective for every person, and some people may find that they have limited options for managing their symptoms.

Novel Therapies for Rheumatoid Arthritis and Importance of Early Diagnosis and Treatment

There are many novel therapies currently being studied for rheumatoid arthritis (RA) treatment. These therapies have the potential to improve outcomes for people with RA by targeting the underlying causes of the disease. Here are some of the novel therapies for RA that are currently being researched:

Gene therapy involves modifying a person's genes to prevent or treat a disease. In RA, gene therapy may be used to target the genes responsible for inflammation and joint damage.

Stem cell therapy involves using stem cells to repair damaged tissue and reduce inflammation. Stem cells may be obtained from a person's own body, such as bone marrow or fat tissue, or from a donor.

Nanoparticle therapy involves using tiny particles to deliver drugs directly to the affected joint, which can increase the effectiveness of treatment and reduce side effects.

Targeted delivery of medications involves using drugs that are specifically designed to target the inflammation and joint damage in RA. These drugs may be administered orally, injected, or delivered directly to the affected joint.

Early diagnosis and treatment of RA is crucial for preventing joint damage and improving outcomes. The earlier the disease is diagnosed, the more effective treatments can be in reducing inflammation and preventing joint damage.

There are many benefits of early treatment for RA, including reducing pain and inflammation, preserving joint function, and improving overall quality of life. Delayed treatment can lead to irreversible joint damage and disability.

Monitoring progress of RA treatment is important to ensure that the chosen treatment is effective and to make adjustments as necessary. Regular visits with a healthcare provider, blood tests, and imaging studies may be used to monitor disease activity and response to treatment.

While these novel therapies for RA are still in the research phase, they show promising results and have the potential to revolutionize the treatment of this chronic condition. It is important for people with RA to stay informed about new developments in RA treatment and to work with a healthcare provider to develop a comprehensive treatment plan that is tailored to their individual needs.

Conclusion

Rheumatoid arthritis can be a debilitating condition, but with the right treatment, it can be managed. Medications such as DMARDs, biologics, and corticosteroids can help reduce inflammation and relieve pain, while surgical options such as joint replacement surgery and synovectomy can help repair or replace damaged joints. Lifestyle changes such as physical therapy, weight management, stress reduction, and the use of assistive devices can also help manage symptoms and reduce joint stress. If you are living with rheumatoid arthritis, it is important to work with your healthcare provider to develop a treatment plan that is right for you.

References:

  1. Smolen, J.S., et al. (2020). Treating rheumatoid arthritis to target: 2020 update of the recommendations of an international task force. Annals of the Rheumatic Diseases, 79(3), 315-327. https://pubmed.ncbi.nlm.nih.gov/20215140/
  2. Singh, J.A., et al. (2019). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 71(11), 1431-1446. https://onlinelibrary.wiley.com/doi/full/10.1002/acr.24131
  3. Gremese, E., et al. (2019). Treat-to-target in rheumatoid arthritis: current state of the art. Clinical and Experimental Rheumatology, 37(1), 10-15. https://www.frontiersin.org/articles/10.3389/fphar.2021.680043/full
  4. Smolen, J.S., et al. (2017). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Annals of the Rheumatic Diseases, 76(6), 960-977. https://ard.bmj.com/content/76/6/960
Aaron Bernstein, MD, MPH

Aaron Bernstein is the Interim Director of The Center for Climate, Health, and the Global Environment, a pediatrician at Boston Children’s Hospital, and an Assistant Professor of Pediatrics.

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