Reumatoidalne zapalenie stawów

Reumatoidalne zapalenie stawów
Leczenie

Reumatoidalne zapalenie stawów (RZS) to przewlekła choroba autoimmunologiczna, której leczenie opiera się na wczesnym i agresywnym stosowaniu leków modyfikujących przebieg choroby (DMARDs), co pozwala na osiągnięcie remisji lub niskiej aktywności choroby oraz minimalizację uszkodzeń stawów. Metotreksat jest lekiem pierwszego wyboru, z działaniem rozpoczynającym się po 6-8 tygodniach, charakteryzującym się dobrym profilem toksyczności i niskim kosztem. W przypadku niewystarczającej odpowiedzi stosuje się terapię potrójną (metotreksat, hydroksychlorochina, sulfasalazyna) lub leki biologiczne (inhibitory TNF-alfa, IL-6, komórek B, kostymulacji limfocytów T) oraz inhibitory JAK (tofacitinib, barycytynib, upadacytynib). NLPZ i kortykosteroidy pełnią rolę leków wspomagających, stosowanych głównie do kontroli objawów i zaostrzeń, przy czym kortykosteroidy powinny być używane w najmniejszych dawkach i przez krótki czas ze względu na ryzyko działań niepożądanych.

Leczenie reumatoidalnego zapalenia stawów

Reumatoidalne zapalenie stawów (RZS) jest przewlekłą chorobą autoimmunologiczną, dla której nie ma obecnie znanych metod wyleczenia. Na szczęście w ostatnich latach nastąpiła zmiana strategii leczenia w kierunku wcześniejszego wdrażania leków modyfikujących przebieg choroby oraz pojawienie się nowych klas leków, co znacznie poprawiło wyniki, które mogą być osiągnięte przez większość pacjentów¹. Celem leczenia RZS jest obecnie osiągnięcie jak najniższej aktywności choroby, a jeśli to możliwe remisji, minimalizacja uszkodzeń stawów oraz poprawa funkcji fizycznych i jakości życia¹².

Optymalne leczenie RZS wymaga kompleksowego programu, który łączy wsparcie medyczne, społeczne i emocjonalne dla pacjenta¹. Niezbędna jest edukacja pacjenta i jego rodziny na temat natury i przebiegu choroby¹. Opcje leczenia obejmują leki, redukcję obciążenia stawów, fizjoterapię, terapię zajęciową oraz interwencje chirurgiczne¹³.

Wczesne rozpoczęcie leczenia

Wczesne, agresywne leczenie RZS może opóźnić uszkodzenie stawów i zapobiec lub spowolnić ich destrukcję⁴⁵. Badania kliniczne pokazują, że złagodzenie objawów, nazywane remisją, jest bardziej prawdopodobne przy wczesnym leczeniu lekami zwanymi lekami modyfikującymi przebieg choroby (DMARDs)⁴. Istnieje „okno terapeutyczne”, podczas którego choroba może być leczona przed wystąpieniem nieodwracalnych uszkodzeń stawów. Okno to różni się między pacjentami, ale zwykle jest otwarte przez 3-6 miesięcy po wystąpieniu objawów⁶.

Farmakoterapia RZS

Istnieją trzy główne klasy leków powszechnie stosowanych w leczeniu reumatoidalnego zapalenia stawów: niesteroidowe leki przeciwzapalne (NLPZ), kortykosteroidy i leki modyfikujące przebieg choroby (DMARDs)⁷. Chociaż zarówno NLPZ, jak i DMARDs łagodzą objawy aktywnego RZS, tylko leki DMARDs wykazały zdolność do zmiany przebiegu choroby i poprawy wyników radiograficznych⁷.

Leki modyfikujące przebieg choroby (DMARDs)

DMARDs mogą znacząco zmniejszyć stan zapalny w RZS, ograniczyć lub zapobiec uszkodzeniom stawów, zachować strukturę i funkcję stawów oraz umożliwić pacjentowi kontynuowanie codziennych aktywności⁸. W większości przypadków, gdy diagnoza RZS zostaje potwierdzona, należy rozpocząć leczenie DMARDs⁷. Obecność nadżerek lub zwężenia przestrzeni stawowej na zdjęciach rentgenowskich zajętych stawów jest wyraźnym wskazaniem do terapii DMARDs, jednak nie należy czekać na pojawienie się zmian w obrazie RTG⁷.

Metotreksat jest obecnie uważany za lek pierwszego wyboru z grupy DMARDs dla większości pacjentów z RZS⁷⁹. Ma on stosunkowo szybki początek działania w dawkach terapeutycznych (6-8 tygodni), dobrą skuteczność, korzystny profil toksyczności, łatwość podawania i stosunkowo niski koszt⁷. Metotreksat jest często pierwszym lekiem przepisywanym osobom z nowo zdiagnozowanym reumatoidalnym zapaleniem stawów¹⁰.

Inne konwencjonalne DMARDs stosowane w leczeniu RZS to:

Hydroksychlorochina – stosunkowo bezpieczny i dobrze tolerowany lek przeciwmalaryczny¹¹
Sulfasalazyna – skuteczny DMARD w leczeniu RZS, choć jego ogólna skuteczność jest nieco mniejsza niż metotreksatu¹¹
Leflunomid – również skuteczny DMARD, o skuteczności podobnej do metotreksatu pod względem objawów¹¹

W przypadku pacjentów, którzy nie osiągają odpowiedniej kontroli choroby przy zastosowaniu metotreksatu w monoterapii, często stosuje się tzw. terapię potrójną – kombinację metotreksatu, hydroksychlorochiny i sulfasalazyny¹².

Leki biologiczne

Leki biologiczne, znane również jako biologiczne DMARDs, są skuteczne w hamowaniu progresji uszkodzeń stawów spowodowanych przez RZS¹³. Są one zwykle stosowane u pacjentów, którzy nie reagują odpowiednio na konwencjonalne DMARDs¹⁴. Leki biologiczne są genetycznie zaprojektowanymi białkami, które blokują określone części układu odpornościowego napędzające zapalenie¹⁵.

Główne grupy leków biologicznych stosowanych w RZS to:

Inhibitory czynnika martwicy nowotworu alfa (TNF-alfa) – w tym adalimumab, certolizumab pegol, etanercept, golimumab i infliksymab¹⁶
Inhibitory interleukiny (IL) – jak tocilizumab (inhibitor IL-6)¹¹¹⁷
Inhibitory komórek B – jak rytuksymab¹¹
Inhibitory kostymulacji limfocytów T – jak abatacept¹¹

Różne leki biologiczne działają w różny sposób w organizmie, więc jeśli jeden nie działa, inny może być skuteczny¹⁵. Wszystkie są podawane w postaci wstrzyknięć lub infuzji¹⁵.

Inhibitory Janus kinazy (JAK)

Inhibitory JAK to najnowsza klasa leków stosowanych w leczeniu RZS¹⁵. Działają one poprzez blokowanie enzymów Janus kinazy 1 (JAK1), JAK2, JAK3 i kinazy tyrozynowej 2, które odgrywają rolę w przekazywaniu sygnałów komórkowych prowadzących do odpowiedzi zapalnej i immunologicznej obserwowanej w RZS¹⁵.

Obecnie stosowane inhibitory JAK w leczeniu RZS to:

Tofacytynib (Xeljanz)
Barycytynib (Olumiant)
Upadacytynib (Rinvoq)¹⁵

Są one przyjmowane doustnie i mogą być stosowane u pacjentów z umiarkowanym do ciężkiego RZS, którzy nie odpowiedzieli odpowiednio na inhibitory TNF¹⁸.

Niesteroidowe leki przeciwzapalne i kortykosteroidy

NLPZ mogą pomóc złagodzić ból i zmniejszyć stan zapalny stawów, chociaż nie zatrzymają postępu reumatoidalnego zapalenia stawów z czasem¹⁹. Są one często stosowane do kontrolowania objawów bólu, obrzęku lub sztywności²⁰.

Kortykosteroidy, takie jak prednizon, są potężnymi lekami przeciwzapalnymi, które mogą pomóc zmniejszyć ból, sztywność i stan zapalny¹⁹²⁰. Są one zwykle stosowane do krótkotrwałego łagodzenia bólu, na przykład w czasie oczekiwania na działanie leków DMARDs lub podczas zaostrzenia choroby²¹. Ze względu na potencjalne długoterminowe działania niepożądane, kortykosteroidy powinny być stosowane w najmniejszej możliwej dawce przez jak najkrótszy czas²².

Strategie leczenia RZS

Podejście „treat-to-target”

Podejście „treat-to-target” (leczenie do celu) jest zalecaną strategią w leczeniu RZS²³⁵. Polega ono na określeniu konkretnego celu terapeutycznego (niska aktywność choroby lub remisja) i systematycznej ocenie odpowiedzi na leczenie za pomocą walidowanych narzędzi do pomiaru aktywności choroby²³. Jeśli cel nie zostanie osiągnięty, leczenie jest modyfikowane zgodnie z ustalonymi protokołami²⁴.

To podejście wymaga regularnych wizyt kontrolnych u reumatologa, aby monitorować aktywność choroby, skuteczność leczenia i potencjalne działania niepożądane⁴.

Terapia skojarzona

Coraz więcej dowodów wskazuje, że kombinacje leków DMARDs mogą być bardziej skuteczne niż monoterapia²⁵. Najczęściej stosowaną kombinacją jest metotreksat z innym DMARDs lub lekiem biologicznym²⁶.

Wykazano, że kombinacja etanerceptu z metotreksatem jest bardziej skuteczna w uzyskiwaniu odpowiedzi klinicznej i zmniejszaniu uszkodzeń stawów niż każdy z tych leków stosowany osobno²⁶.

Leczenie RZS o różnym nasileniu

Leczenie RZS jest dostosowywane do nasilenia choroby:

Przy niskiej aktywności choroby można rozważyć początkowe leczenie hydroksychlorochiną, sulfasalazyną, metotreksatem lub leflunomidem²⁷
Przy umiarkowanej do wysokiej aktywności choroby, metotreksat jest najlepszym początkowym leczeniem²⁷
Jeśli pacjent nie odpowiada odpowiednio na metotreksat w monoterapii, dodaje się inny lek²⁷

Badania wykazały, że terapia potrójna (kombinacja metotreksatu, hydroksychlorochiny i sulfasalazyny) jest równie skuteczna jak dodanie leku biologicznego lub ukierunkowanego syntetycznego DMARDs²⁷.

Monitorowanie i dostosowywanie leczenia

Regularny monitoring aktywności choroby jest kluczowy dla skutecznego leczenia RZS²⁸. Pacjenci powinni być oceniani co 3 miesiące po każdej zmianie terapii lub co 6 miesięcy, jeśli stosowany jest lek niebędący inhibitorem TNF²⁹.

Jeśli po 3 miesiącach leczenia inhibitorem TNF lub 6 miesiącach leczenia innym lekiem utrzymuje się umiarkowana lub wysoka aktywność choroby z powodu braku lub utraty korzyści lub niegroźnego działania niepożądanego, zaleca się zmianę na inny inhibitor TNF lub lek niebędący inhibitorem TNF²⁹.

Niefarmakologiczne metody leczenia

Fizjoterapia i terapia zajęciowa

Regularna aktywność fizyczna jest ważnym elementem planu leczenia RZS³. Może pomóc zapobiegać i odwracać skutki choroby, wzmacniając mięśnie i zachowując zakres ruchu w stawach⁸.

Wiele osób z RZS korzysta ze współpracy z doświadczonym fizjoterapeutą³. Fizjoterapeuta może stworzyć program poprawy siły i mobilności oraz pokazać, jak poruszać się w sposób, który pomoże i nie spowoduje dalszych uszkodzeń³.

Oprócz ćwiczeń zalecanych przez fizjoterapeutę, istnieje wiele aktywności, które można wykonywać samodzielnie, aby utrzymać lub poprawić mobilność stawów, budować mięśnie, wzmacniać układ sercowo-naczyniowy i promować ogólne zdrowie i dobre samopoczucie³. Popularne i bezpieczne opcje dla osób z RZS obejmują chodzenie, pływanie, ćwiczenia w wodzie, aerobik o niskiej intensywności i jazdę na rowerze stacjonarnym³.

Modyfikacje stylu życia

Oprócz fizjoterapii i leków, można zrobić wiele rzeczy na własną rękę, aby przejąć kontrolę nad zdrowiem i ogólnie czuć się lepiej³⁰:

Aktywne uczestnictwo w decyzjach dotyczących leczenia i bycie dobrym samozarządzającym³⁰
Śledzenie objawów, leków, skutków ubocznych i poziomów bólu³⁰
Regularne badania kontrolne i aktualne szczepienia³⁰
Zadawanie pytań i dzielenie się obawami z zespołem opieki zdrowotnej³⁰
Jeśli palisz, rzuć palenie. Palenie zwiększa stan zapalny i może prowadzić do cięższego RZS³⁰

Ponieważ otyłość obciąża układ mięśniowo-szkieletowy, należy osiągnąć i utrzymywać idealną masę ciała³¹.

Dieta i suplementy

Nie ma silnych dowodów sugerujących, że konkretne zmiany dietetyczne mogą poprawić reumatoidalne zapalenie stawów, chociaż niektórzy pacjenci z RZS czują, że ich objawy pogarszają się po spożyciu określonych pokarmów²¹.

Badania nad zastosowaniem diety śródziemnomorskiej wykazały pewne korzyści w zmniejszaniu stanu zapalnego i bólu u pacjentów z RZS³²⁸.

Badania pokazują, że suplementy kurkuminy/kurkumy i oleju rybiego z omega-3 mogą pomóc w bólu reumatoidalnego zapalenia stawów i porannej sztywności³³. Jednak przed zażyciem jakiegokolwiek suplementu należy porozmawiać z lekarzem na temat skutków ubocznych i tego, jak może on wpłynąć na inne przyjmowane leki³³.

Leczenie chirurgiczne

Chociaż reumatoidalne zapalenie stawów jest zasadniczo procesem zapalnym błony maziowej, strukturalne lub mechaniczne zaburzenie jest częstą przyczyną bólu lub utraty funkcji stawu³¹. Ból i mobilność stawów mogą być poprawione poprzez podejście chirurgiczne³¹.

Lepsze leki do leczenia reumatoidalnego zapalenia stawów zmniejszyły potrzebę operacji³⁴. Jednak jeśli leki nie zapobiegają lub nie spowalniają uszkodzenia stawów, pacjent i jego lekarz mogą rozważyć operację uszkodzonych stawów³⁴.

Zabiegi chirurgiczne stosowane w leczeniu RZS obejmują:

Synowektomię (usunięcie zapalnej błony maziowej)
Tenosynowektomię
Repozycję ścięgien
Chirurgię rekonstrukcyjną lub artroplastykę
Artrodezę (usztywnienie stawu)²³

Operacja może pomóc w ponownym użyciu stawu i złagodzić ból³⁴.

Terapie komplementarne i alternatywne

Wiele osób z reumatoidalnym zapaleniem stawów próbuje komplementarnych i alternatywnych terapii, takich jak akupunktura, chiropraktyka, masaż i osteopatia²¹.

W większości przypadków nie ma silnych dowodów, że są one skuteczne w długim okresie, chociaż niektórzy ludzie mogą doświadczyć krótkotrwałych korzyści²¹.

Ogólnie rzecz biorąc, metody CAM (medycyny komplementarnej i alternatywnej), które pomagają pacjentom relaksować się i równoważyć stres fizyczny/emocjonalny, mogą być korzystne z różnych powodów³⁵.

Leczenie RZS w szczególnych przypadkach

Leczenie podczas ciąży

Leczenie reumatoidalnego zapalenia stawów podczas ciąży jest skomplikowane przez fakt, że żaden z opisanych powyżej leków nie został uznany za bezpieczny do stosowania u kobiet w ciąży w odpowiednich kontrolowanych badaniach³¹.

Niektóre leki stosowane w leczeniu RZS nie są bezpieczne do stosowania podczas ciąży³⁶. Ważne jest, aby omówić plany dotyczące ciąży z lekarzem prowadzącym.

Leczenie zaostrzeń

Zaostrzenia to okresy, w których objawy RZS tymczasowo się pogarszają; mogą one wystąpić oprócz trwającego stanu zapalnego³⁷.

Sterydy mogą być również stosowane do leczenia zaostrzeń choroby, gdy osoba otrzymuje inne leczenie³⁷.

Szczepienia u pacjentów z RZS

Najlepszym sposobem zapobiegania infekcjom są szczepienia, dlatego szczepienia są często zdecydowanie zalecane dla osób z RZS, w tym szczepienia przeciwko COVID-19, zapaleniu płuc, półpaścowi i grypie³⁷.

Pacjenci przyjmujący inhibitory TNF muszą unikać szczepionek zawierających żywe wirusy³⁸.

Nowe kierunki w leczeniu RZS

Badacze zidentyfikowali nowe i eksperymentalne terapie, które mogą pomóc złagodzić objawy i zminimalizować uszkodzenia stawów³⁹. Obejmują one:

Inhibitory Bruton kinazy tyrozynowej (BTK) – eksperymentalny lek o nazwie fenebrutynib, który blokuje działanie enzymu BTK, promującego stan zapalny w organizmie³⁹
Stymulacja nerwu błędnego – leczenie wykorzystujące impulsy elektryczne do stymulacji nerwu błędnego, który biegnie od pnia mózgu do żołądka⁴⁰
Terapia mezenchymalnymi komórkami macierzystymi (MSC) – badana jako obiecujące leczenie RZS ze względu na jej potencjał do spowolnienia progresji RZS, naprawy i regeneracji uszkodzonych stawów i tkanek oraz zmniejszenia bólu i obrzęku⁴⁰

Badania są również prowadzone nad zastosowaniem biodegradowalnych systemów polimerowych do dostarczania leków bezpośrednio do zajętych stawów, co może poprawić skuteczność leczenia przy jednoczesnym minimalizowaniu ogólnoustrojowych działań niepożądanych⁴¹⁴².

Podsumowanie leczenia RZS

Leczenie reumatoidalnego zapalenia stawów jest kompleksowe i wymaga indywidualnego podejścia. Wczesne, agresywne leczenie z zastosowaniem DMARDs jest kluczowe dla zapobiegania uszkodzeniom stawów i zachowania funkcji. Metotreksat pozostaje lekiem pierwszego wyboru dla większości pacjentów, ale w przypadku niewystarczającej odpowiedzi dostępnych jest wiele opcji, w tym terapie skojarzone, leki biologiczne i inhibitory JAK.

Poza farmakoterapią, istotną rolę odgrywają fizjoterapia, modyfikacje stylu życia i, w wybranych przypadkach, interwencje chirurgiczne. Regularne monitorowanie i dostosowywanie leczenia zgodnie z podejściem „treat-to-target” pozwala osiągnąć optymalną kontrolę choroby.

Badania nad nowymi metodami leczenia trwają, dając nadzieję na jeszcze skuteczniejsze opcje terapeutyczne w przyszłości. Kluczowa jest ścisła współpraca pacjenta z reumatologiem i zespołem terapeutycznym, aby zoptymalizować wyniki leczenia i poprawić jakość życia.

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Materiały źródłowe

#1 Rheumatoid Arthritis Treatment Options | Johns Hopkins Arthritis Center
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
Rheumatoid arthritis is a chronic disorder for which there is no known cure. Fortunately in the last few years, a shift in strategy toward the earlier institution of disease modifying drugs and the availability of new classes of medications have greatly improved the outcomes that can be expected by most patients. The goal of rheumatoid arthritis treatment now aims toward achieving the lowest possible level of arthritis disease activity and remission if possible, minimizing joint damage, and enhancing physical function and quality of life. The optimal treatment of RA requires a comprehensive program that combines medical, social, and emotional support for the patient. It is essential that the patient and the patients family be educated about the nature and course of the disease. Treatment options include medications, reduction of joint stress, physical and occupational therapy, and surgical intervention.
#2 Rheumatoid Arthritis (RA): Symptoms, Stages & Treatment
https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis
Rheumatoid arthritis is a type of arthritis where your immune system attacks the tissue lining the joints on both sides of your body. Treatment options include lifestyle changes, physical therapy, occupational therapy, nutritional therapy, medication and surgery. […] The most important goal of treating rheumatoid arthritis is to reduce joint pain and swelling. Doing so should help maintain or improve joint function. The long-term goal of treatment is to slow or stop joint damage. Managing joint inflammation reduces your pain and improves your quality of life. […] Rheumatoid arthritis treatments typically include one or more kinds of medication. In certain cases, your provider may recommend surgery. Your provider considers your age, health, medical history and how bad your symptoms are when deciding on a treatment.
#3 Treatments for Rheumatoid Arthritis | Arthritis Foundation
https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-rheumatoid-arthritis
Every medication comes with risks and possible side effects. It is important to ask your doctor about your medication risks and what to do if you experience side effects. […] Regular physical activity is an important piece of your overall treatment plan. It can help preserve range of motion in your joints and strengthen the muscles that support them. […] Many people with RA benefit from working with an experienced physical therapist (PT). A PT can create a strength and mobility program for you and show you how to move in ways that will help and won’t cause further damage. A physical therapist can also teach you pain relief techniques and prescribe splints and braces to support damaged joints. […] In addition to exercises prescribed by a physical therapist, there are many activities you can do on your own to maintain or improve joint mobility, build muscles, strengthen your cardiovascular system and promote general health and well-being. The right form of activity for you depends not only on which joints are affected and the severity of your disease, but also on your interests. The best exercises are those you enjoy enough to do regularly. Popular and safe options for people with RA include walking, swimming, water exercise, low-impact aerobics and stationary cycling.
#4 Rheumatoid arthritis – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
There is no cure for rheumatoid arthritis. Joint damage can happen quickly without treatment. But clinical studies show that easing of symptoms, called remission, is more likely with early treatment with medicines called disease-modifying antirheumatic drugs (DMARDs). […] Treatment of rheumatoid arthritis also involves regular follow-up with your healthcare team. This is to watch for joint damage, to see whether treatment is working and to look for possible side effects of treatment. […] Your healthcare professional will suggest medicines based on how bad your symptoms are and how long you’ve had rheumatoid arthritis. You and your healthcare professional will decide on treatment. […] A physical or occupational therapist can teach you exercises to help keep your joints moving. The therapist also may suggest ways to do daily tasks that are easier on your joints.
#5 Treatment for Rheumatoid Arthritis: Medication, Alternative and Complementary Therapies, Surgery Options, and More
https://www.everydayhealth.com/rheumatoid-arthritis/guide/treatment/
There’s no known cure for this condition. Treatment instead focuses on effectively stopping the progression of the disease in the following ways: […] Drugs, physical therapy, and surgery are proven therapies for rheumatoid arthritis. […] Treat-to-target is a new treatment paradigm for rheumatoid arthritis that involves doctors and patients having an open and ongoing discussion about the target for treatment. […] Early, aggressive treatment of RA can help control symptoms and complications before the disease significantly worsens, by reducing or altogether stopping inflammation as quickly as possible. […] There are three main categories of medication for rheumatoid arthritis: Disease-modifying antirheumatic drugs (DMARDs), including biologic DMARDs and targeted synthetic DMARDs called JAK inhibitors; Corticosteroids; Nonsteroidal anti-inflammatory drugs (NSAIDs).
#6 Early Diagnosis and Treatment of Rheumatoid Arthritis | HSS
https://www.hss.edu/conditions_early-diagnosis-inflammatory-arthritis.asp
In early arthritis there is a „window of opportunity, during which the disease can be treated before irreversible joint damage occurs. This window varies between patients but is usually open 3 to 6 months after the onset of the disease. For this reason, RA should be addressed in a timely manner. […] A multipronged approach is essential for RA treatment, including patient education, nonpharmacologic therapy, pain medications (such as NSAIDs), DMARDs and biologic agents, and/or surgery: […] Patient education: As early as possible after diagnosis, it is important for the patient to learn about his/her disease in order to anticipate its symptoms, effects, treatments, and potential outcomes. […] Nonpharmacologic therapy can be extremely helpful in patients’ efforts to manage their disease a physical therapist or occupational therapist is essential in aiding the patient’s physical recuperation as concurrent pharmacologic treatment modalities are administered.
#7 Rheumatoid Arthritis Treatment Options | Johns Hopkins Arthritis Center
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). […] Although both NSAIDs and DMARD agents improve symptoms of active rheumatoid arthritis, only DMARD agents have been shown to alter the disease course and improve radiographic outcomes. DMARDs have an effect upon rheumatoid arthritis that is different and may be slower. In most cases, when the diagnosis of rheumatoid arthritis is confirmed, DMARD agents should be started. The presence of erosions or joint space narrowing on x-rays of the involved joints is a clear indication for DMARD therapy, however one should not wait for x-ray changes to occur. […] Methotrexate is now considered the first-line DMARD agent for most patients with RA. It has a relatively rapid onset of action at therapeutic doses (6-8 weeks), good efficacy, favorable toxicity profile, ease of administration, and relatively low cost.
#8 Patient education: Rheumatoid arthritis treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics/print
Smoking is a risk factor for RA, and quitting smoking can improve symptoms and reduce the risk of lung cancer and lung infections, which are more common with RA. […] Medications are the cornerstone of treatment when rheumatoid arthritis (RA) symptoms are active. The goals of medication treatment are to achieve remission of symptoms and signs of RA and prevent further damage of the joints and loss of function, without causing permanent or unacceptable side effects. […] Almost all people with RA should be prescribed a disease-modifying antirheumatic drug (DMARD). In addition, they may be prescribed nonsteroidal antiinflammatory drugs (NSAIDs), steroids, and, if needed, pain medications. […] Disease-modifying antirheumatic drugs (DMARDs) can substantially reduce the inflammation of RA, reduce or prevent joint damage, preserve joint structure and function, and enable a person to continue his or her daily activities.
#8 Patient education: Rheumatoid arthritis treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics/print
Long-term medical care with a provider you trust is essential for the successful management of RA. This involves regular visits and tests to assess how well your treatment is working and monitor you for possible side effects. […] Almost all people with rheumatoid arthritis (RA) require some form of medication to control their disease. This does not diminish the importance of nonpharmacologic (non-drug) therapies, which can improve quality of life, help control symptoms, and minimize joint damage. […] Education and counseling can help you to better understand the nature of RA and cope with the challenges of your condition. […] Regular physical activity can help prevent and reverse these effects. […] Specific types of therapy are used to address specific effects of RA. […] Specific changes in diet have been studied as potential treatments for RA, with the Mediterranean diet showing some benefits at reducing inflammation and pain.
#9
https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
Treatments for rheumatoid arthritis can help reduce inflammation in the joints, relieve pain, prevent or slow down joint damage, reduce disability and enable you to be as active as possible. […] Although there’s no cure for rheumatoid arthritis, early treatment and support (including medicine, lifestyle changes, supportive treatments and surgery) can reduce the risk of joint damage and limit the impact of the condition. […] Your treatment will usually involve care from your GP and several different specialists. […] There are medicines available to help stop rheumatoid arthritis from getting worse and reduce your risk of further problems. […] These are often divided into main 2 types: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments. […] If you’ve been diagnosed with rheumatoid arthritis, you’ll usually be offered a combination of DMARD tablets as part of your initial treatment.
#10 5 Types of Medication That Treat Rheumatoid Arthritis (RA)
https://www.arthritis-health.com/types/rheumatoid/5-types-medication-treat-rheumatoid-arthritis-ra
Methotrexate is often the first drug prescribed for people newly diagnosed with rheumatoid arthritis. RA patients take this medication weekly, alone or in combination with other medications. […] Biologic drugs target and prevent a specific reaction from happening, stopping the inflammatory process. […] This class of medications, called biologic response modifiers, is technically a subset of DMARDs. […] Biologics fall into four categories: Tumor necrosis factor (TNF) inhibitors; Interleukin (IL) inhibitors; B-cells inhibitors; and T-cells inhibitors. […] JAK inhibitors bind to JAK enzymes, preventing them from binding with X Cells and stopping the inflammatory process. […] The first FDA-approved JAK inhibitor is called Tofacitinib, and it is sold under the names Xeljanz and Xeljanz XR (extended release).
#11 Rheumatoid Arthritis Treatment Options | Johns Hopkins Arthritis Center
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
Hydroxychloroquine is an antimalarial drug which is relatively safe and well-tolerated agent for the treatment of rheumatoid arthritis. […] Sulfasalazine is an effective DMARD for the treatment of RA. Its effectiveness overall is somewhat less than that methotrexate, but it has been shown to reduce signs and symptoms and slow radiographic damage. […] Leflunomide is also an effective DMARD. Its efficacy is similar to methotrexate in terms of signs and symptoms, and is a viable alternative to patients who have failed or are intolerant to methotrexate. […] Tumor necrosis factor alpha (TNF) is a pro-inflammatory cytokine produced by macrophages and lymphocytes. […] Abatacept is the first of a class of agents known as T-cell costimulatory blockers. […] Rituximab is currently available for the treatment of rheumatoid arthritis.
#12 Management of Rheumatoid Arthritis: Update From ACR | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0900/practice-guidelines-rheumatoid-arthritis.html
In patients with rheumatoid arthritis, hydroxychloroquine is recommended for initial treatment in those with low disease activity. […] Methotrexate is recommended for initial treatment of patients with rheumatoid arthritis and moderate or high disease activity. […] Rheumatoid arthritis treatment should be targeted to a standardized disease activity scale. […] In patients with rheumatoid arthritis who do not achieve low disease activity with methotrexate, triple therapy with the addition of sulfasalazine and hydroxychloroquine is as effective as adding a biologic or targeted synthetic medication, although response will be slower. […] Disease-modifying antirheumatic drugs (DMARDs) are the key to treating rheumatoid arthritis, and timely initiation can prevent joint damage. […] For patients without previous DMARD use, treatment recommendations are stratified by disease activity using patient ratings and inflammation measures.
#13 Rheumatoid Arthritis: A Brief Overview of the Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC6422329/
The overall goal of first-line treatment is to relieve pain and decrease inflammation. […] The overall goal of second-line treatment is to promote remission by slowing or stopping the progression of joint destruction and deformity. […] Leflunomide is an oral medication that is converted to malononitrilamide, which inhibits the synthesis of ribonucleotide uridine monophosphate pyrimidine. It relieves symptoms and retards the progression of RA. […] Biologics, also known as biological DMARDs, are rapidly effective in retarding the progression of the joint damage caused by RA. […] Surgery is a last resort for the treatment of RA. Indications include intractable joint pain or functional decline due to joint destruction after all nonsurgical approaches have failed. […] It has been found that, in contrast to suggestions in the past, there are no specific foods that patients with RA should avoid.
#14 Treatment of rheumatoid arthritis | Comprehensive Rheumatology
https://comprehensiverheumatology.com/index.html@p=277.html
Choice of medications in rheumatoid arthritis treatment is usually individualized, depending on the persons risk factors, comorbid conditions, and potential side effects. Several classes of medications can be used to treat rheumatoid arthritis, and medications from two or more classes may be combined to achieve the desired outcome. […] These potent medications have truly revolutionized the treatment of rheumatoid arthritis in the recent decades. These drugs each target a specific component of the immune system, thus cooling down an otherwise angry immune system. Infection is a potential, though infrequent, side effect of these drugs. A tuberculosis test is usually required before starting most biologic drugs to rule out dormant or active tuberculosis that can activate once the immune system is lowered. These drugs are usually used in people who have had inadequate response to DMARDs. They are often combined with DMARDs like methotrexate.
#15 Treatments for Rheumatoid Arthritis | Arthritis Foundation
https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-rheumatoid-arthritis
Treatments for Rheumatoid Arthritis […] Learn what medical treatments are available for RA and what you can do to manage your disease. […] Getting control of rheumatoid arthritis (RA) and the inflammation that fuels it involves medication, physical activity and living a healthy lifestyle. You should work closely with your doctor and other health care professionals to create a treatment plan that works well for you. […] The goal of treatment for rheumatoid arthritis is to […] Reduce pain and stiffness […] Slow or stop the progression of the disease […] Prevent joint damage […] Improve physical function so you can perform normal daily activities […] Relieve fatigue and weakness. […] Medications are an essential part of treatment for most people with RA. Your treatment plan will likely include some of the following: […] NSAIDs. In low doses, nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective at relieving pain. At higher, prescription doses they can also help control inflammation. […] DMARDs. Conventional synthetic disease-modifying antirheumatic drugs (DMARDs), primarily methotrexate, may be the first medication you are prescribed to slow disease activity in RA. Other DMARDs used in RA treatment include leflunomide, hydroxychloroquine and sulfasalazine. Sometimes two or more DMARDs are used together. […] Biologics. Biologics are genetically engineered proteins that target specific parts of the immune system that fuel inflammation. They are typically used if your disease doesn’t respond to conventional DMARDs. Different biologics work in different ways in the body, so if one doesn’t work, another one might. All are given by injection or infusion. […] Janus kinase (JAK) inhibitors. The newest class of drugs for RA, JAK inhibitors work by blocking the enzymes Janus kinase 1 (JAK1), JAK2, JAK3, and tyrosine kinase 2, which play a role in cell signaling that leads to the inflammatory and immune responses seen in RA and other conditions. There are currently three JAK inhibitors used to treat RA: tofacitinib (Xeljanz), baracitinib (Olumiant) and upadacitinib (Rinvoq). They are taken orally. […] Analgesics. The pain reliever acetaminophen can ease pain if you aren’t able to take NSAIDs. It won’t reduce inflammation. […] Corticosteroids. Similar to the cortisone your body makes naturally, corticosteroid medications are potent anti-inflammatories. Your doctor may prescribe oral corticosteroids to reduce inflammation that can damage joints and organs, usually while you are waiting for slower-acting, disease-modifying drugs to take effect.
#16 Biological Treatment for Rheumatoid Arthritis
https://patient.info/bones-joints-muscles/rheumatoid-arthritis-leaflet/biological-medicines-for-rheumatoid-arthritis
Biological medicines are a newer type of medicine, used to ease the symptoms of rheumatoid arthritis and reduce the damaging effect of the disease on the joints. They are usually prescribed when you have tried older medicines called disease-modifying antirheumatic drugs (DMARDs) and these have not worked so well. […] Biological medicines work in rheumatoid arthritis by blocking chemicals in the body that are involved in inflammation. […] Biological medicines are usually prescribed when you have taken at least two DMARDs for six months and your rheumatoid arthritis has not improved. […] A biological medicine that blocks TNF-alpha (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab), other biological DMARD (abatacept, sarilumab, or tocilizumab), or a targeted synthetic DMARD (baricitinib, filgotinib, tofacitinib, or upadacitinib) is recommended if there has been an inadequate response to combination therapy with conventional DMARDs.
#17 Rheumatoid Arthritis Treatment Options | Johns Hopkins Arthritis Center
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
Tocilizumab is the first approved drug in a class of IL-6 inhibitors. […] Anakinra, a human recombinant IL-1 receptor antagonist (hu rIL-1ra), is approved for the treatment of RA. […] Pain caused by inflammation is best treated with an anti-inflammatory drug (see above), although occasionally the addition of acetaminophen can be helpful. […] Rheumatoid arthritis therapy during pregnancy is complicated by the fact that none of the drugs discussed above have been shown to be safe in pregnant women with adequate, controlled studies. […] Because obesity stresses the musculoskeletal system, ideal body weight should be achieved and maintained. […] Although rheumatoid arthritis is generally an inflammatory process of the synovium, structural or mechanical derangement is a frequent cause of pain or loss of joint function. Pain and joint mobility may be improved by a surgical approach.
#18 RINVOQÂ® (upadacitinib) for Rheumatoid Arthritis (RA)
https://www.rinvoq.com/rheumatoid-arthritis
RINVOQ is a JAK inhibitor for adults with moderate to severe rheumatoid arthritis (RA) in whom TNF blockers did not work well. […] Proven in clinical studies, RINVOQ can tame joint pain, swelling, and stiffness. […] RINVOQ is a prescription medicine used to treat adults with moderate to severe rheumatoid arthritis (RA) when 1 or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or could not be tolerated. […] If you’re still experiencing RA symptoms after a TNF blocker like HUMIRA or ENBREL, RINVOQ works differentlyâit’s a JAK inhibitor. […] Finding an RA treatment that’s right for you takes assessing your symptoms, setting goals, and working with a rheumatologist to develop a treatment plan.
#19
https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
In addition to the medicines used to control the progression of rheumatoid arthritis, you may also need to take medicine specifically to relieve pain. […] In some cases, you may be advised to use painkillers, such as paracetamol or a combination of paracetamol and codeine (co-codamol), to relieve the pain associated with rheumatoid arthritis. […] These medicines do not treat the inflammation in your joints, but they may be helpful in relieving pain in some people. […] In addition to, or instead of, painkillers such as paracetamol, your doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID). […] These medicines can help relieve pain while also reducing inflammation in the joints, although they will not stop rheumatoid arthritis getting worse over time. […] Steroids are powerful medicines that can help reduce pain, stiffness and inflammation.
#20 Rheumatoid arthritis | Causes, symptoms, treatments
https://versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/
Corticosteroids help to reduce the pain, stiffness and inflammation caused by rheumatoid arthritis. […] NSAIDs can be used to help control symptoms of pain, swelling or stiffness. […] Keeping physically active can improve your rheumatoid arthritis symptoms, including pain. […] A physiotherapist can suggest suitable exercises for you and support you in keeping active. […] Complementary treatments can be useful when used alongside prescribed medicines for the treatment of rheumatoid arthritis. However, they should not replace your prescribed medicines and you should talk to your rheumatology team before starting a complementary treatment.
#21
https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
They’re usually used to provide short-term pain relief for example, while you’re waiting for DMARD medicines to take effect or during a flare-up. […] Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms. […] Sometimes, despite taking medicines, your joints may still become damaged. If this happens, you may need surgery to help restore your ability to use your joint. […] Surgery may also be recommended to reduce pain or fix deformities. […] Many people with rheumatoid arthritis try complementary therapies, such as acupuncture, chiropractic, massage, and osteopathy. […] In most cases, there’s little or no evidence these are effective in the long term, although some people may experience short-term benefit from them. […] There’s no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods. […] But it’s important to ensure your overall diet is still healthy and balanced.
#22 Diagnosis and Management of Rheumatoid Arthritis | AAFP
https://www.aafp.org/pubs/afp/issues/2005/0915/p1037.html
Patient education, preferably one-to-one, should be provided when rheumatoid arthritis is diagnosed. […] Intra-articular corticosteroid injections can be helpful but should not be administered more than three times in one year. […] Low-dose oral corticosteroids are effective for symptom relief but have a high risk of toxicity; therefore, the lowest dosage possible should be used for the shortest period possible. […] Combination therapy may be more effective than treatment with one drug alone. […] A multidisciplinary team approach is beneficial, at least in the short term; therefore, patients should have access to a wide range of health care professionals, including their primary care physicians, rheumatologists, nursing specialists, physical therapists, occupational therapists, dietitians, podiatrists, pharmacists, and social workers.
#23 Rheumatoid Arthritis (RA) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Considerations for Specific Patient Presentations
https://emedicine.medscape.com/article/331715-treatment
A treat-to-target approach is recommended for RA, with the target being low disease activity or remission, as determined by validated instruments for measuring disease activity. […] Surgical procedures used in the treatment of RA include the following: Synovectomy, Tenosynovectomy, Tendon realignment, Reconstructive surgery or arthroplasty, Arthrodesis. […] Once a diagnosis of RA is made, the main treatment goals are to control disease activity and slow the rate of joint damage, in addition to minimizing pain, stiffness, inflammation, and complications. Pharmacologic therapies that are used include nonbiologic and biologic DMARDs and adjunctive agents such as corticosteroids, NSAIDs, and analgesics. […] Many studies have revealed that early treatment of RA (ie, within months of onset) with DMARDs not only can retard disease progression more efficiently than later treatment but also may induce more remissions.
#24 Current Therapeutic Options in the Treatment of Rheumatoid Arthritis
https://www.mdpi.com/2077-0383/8/7/938
To relieve pain and swelling fast and to gain control of the inflammation, glucocorticoids (GC) are used widely in acute disease flares either orally or as intraarticular injections. […] To control inflammation in the long run, Disease Modifying Anti-Rheumatic Drugs (DMARD) to spare GC are needed. […] The treatment of patients with RA aims to relieve pain and to control inflammation, and the final goal is to achieve remission or at least low disease activity for all patients. […] An algorithm based on the EULAR recommendations is shown in Figure 1. […] By now, there is evidence from different studies that the T2T principle is superior, and it forms part of the treatment guidelines of the European League Against Rheumatism and the American College of Rheumatology. […] As soon as the diagnosis of rheumatoid arthritis is made, a treatment with a csDMARD should be started.
#25 Diagnosis and Management of Rheumatoid Arthritis | AAFP
https://www.aafp.org/pubs/afp/issues/2005/0915/p1037.html
Increasing evidence indicates that combinations of DMARDs can be more effective than single-drug regimens. […] Several new drugs with novel mechanisms of action have emerged in recent years, including leflunomide, tumor necrosis factor (TNF) antagonists, and anakinra (Kineret). […] Anakinra is a recombinant interleukin-1 receptor antagonist. Several randomized controlled trials have found it to be more effective than placebo when administered alone or in combination with methotrexate. […] A number of additional, nonpharmacologic treatments for rheumatoid arthritis have been tried. […] Rheumatoid arthritis is a lifelong illness. Combinations of methotrexate and the new biologic agents can lead to remission in 30 to 40 percent of patients with rheumatoid arthritis, but for most patients, significant disease persists despite treatment. […] Treatment should be guided by individual clinical response to various interventions. Changes in hemoglobin, ESR, and CRP may serve as helpful indicators of response to treatment, but platelet count and rheumatoid factor levels tend not to correlate well.
#26 Options for Treating Early Inflammatory Arthritis
https://www.hss.edu/conditions_treating-early-inflammatory-arthritis.asp
Slow-acting agents for rheumatoid arthritis have been the mainstay of management of RA for many years. […] Hydroxychloroquine continues to be used in RA in view of documented clinical benefit and relatively low toxicity. […] There is some evidence that sulfasalazine can decrease joint damage over time. […] Methotrexate is the most commonly used long-term agent for RA and is also the most common agent used in combination with other agents, such as the biologics. […] Leflunomide has also been shown to slow damage in RA joints. […] Biologic Therapy in RA. […] The inflammatory process in RA and other types of inflammatory arthritis can be thought of as a tipping of the cytokine balance in favor of pro-inflammatory cytokines. […] The combination of etanercept with methotrexate has been shown to be more effective in producing clinical response and decreasing joint damage than either agent alone, but etanercept can be used alone.
#27 Management of Rheumatoid Arthritis: Update From ACR | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0900/practice-guidelines-rheumatoid-arthritis.html
With low disease activity, consider, in this order, initial treatment with hydroxychloroquine, sulfasalazine, methotrexate, and leflunomide. […] With moderate to high disease activity, methotrexate is the best initial treatment for rheumatoid arthritis. […] Combination therapy is not recommended for initial treatment because it is unnecessary for many patients and incurs higher toxicity and cost. […] Because initial treatment depends on disease activity measured by a standard scale, optimal doses should be determined by target disease activity. […] For patients without adequate symptom control on methotrexate alone, another medication should be added. […] Studies demonstrate that triple therapy, a combination of methotrexate, hydroxychloroquine, and sulfasalazine, is as effective as adding a bDMARD or tsDMARD.
#28 Rheumatoid Arthritis
https://rheumatology.org/patients/rheumatoid-arthritis
Rheumatoid arthritis (RA) is the most common autoimmune type of arthritis. […] RA is a chronic condition and there is no cure currently, however; there are many ways to treat and manage symptoms. […] Once diagnosed, treatments for RA aim to lower inflammation, ease symptoms like pain or swelling, and prevent long-term joint damage. […] A disease-modifying anti-rheumatic drug (DMARD) is usually the first treatment usually prescribed for RA. […] If DMARDs alone dont control RA inflammation, a rheumatologist may prescribe a biologic drug such as abatacept, adalimumab, etanercept, tocilizumab, or medications such as tofacitinib or upadacitinib. […] A rheumatologist will help find a treatment plan that is best for you. […] Regular follow up with your rheumatologist is key to proper disease control and reduced risk of joint damage.
#29 Rheumatoid Arthritis: Aggressive New Treatment Guidelines
https://www.uspharmacist.com/article/rheumatoid-arthritis-aggressive-new-treatment-guidelines
The choice of drug is often determined by cost, dosing frequency, patient preference, and insurance formulary. […] Monitoring for response to therapy is accomplished through rating scales, disease activity scores (DAS), clinical status, and laboratory follow-up. […] In early RA, patients should be started on DMARD monotherapy or combination therapy. […] Methotrexate is the gold standard; however, if it is contraindicated or not tolerated, sulfasalazine, hydroxycholorquine, minocycline, and leflunomide may be used first-line. […] Patients with established RA should be reassessed 3 months after any changes to therapy, or in 6 months if a non-TNF agent is being used. […] If moderate or high disease activity persists owing to a lack or loss of benefit or a nonserious AE after 3 months of anti-TNF therapy or 6 months of non-TNF therapy, it is recommended to switch to another anti-TNF or non-TNF agent.
#30 Treatments for Rheumatoid Arthritis | Arthritis Foundation
https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-rheumatoid-arthritis
You should speak with your doctor before beginning any new exercise plan. […] Along with physical therapy and medications, you can do many things on your own to take charge of your health and feel better overall. […] Be an active participant in your treatment decisions and become a good self-manager. […] Keep track of symptoms, medications, side effects and pain levels. […] Get regular check-ups and keep up with your immunizations. […] Ask questions and share concerns with your health care team. […] If you smoke, stop. Smoking increases inflammation and may lead to more severe RA. Research shows it may also affect your response to treatment, making RA difficult to control. […] If you have limited mobility, self-help devices can make your daily tasks easier. An occupational therapist can advise you about aids and assistive devices.
#31 Rheumatoid Arthritis Treatment Options | Johns Hopkins Arthritis Center
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
Tocilizumab is the first approved drug in a class of IL-6 inhibitors. […] Anakinra, a human recombinant IL-1 receptor antagonist (hu rIL-1ra), is approved for the treatment of RA. […] Pain caused by inflammation is best treated with an anti-inflammatory drug (see above), although occasionally the addition of acetaminophen can be helpful. […] Rheumatoid arthritis therapy during pregnancy is complicated by the fact that none of the drugs discussed above have been shown to be safe in pregnant women with adequate, controlled studies. […] Because obesity stresses the musculoskeletal system, ideal body weight should be achieved and maintained. […] Although rheumatoid arthritis is generally an inflammatory process of the synovium, structural or mechanical derangement is a frequent cause of pain or loss of joint function. Pain and joint mobility may be improved by a surgical approach.
#32 Rheumatoid Arthritis : Complementary and Alternative Medicine Options
https://www.hopkinsarthritis.org/patient-corner/disease-management/ra-complementary-alternative-medicine/
Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disease that impacts joints and connective tissue. It is often painful and disabling, and usually requires lifelong pharmacological management. Patients are usually diagnosed between the ages of thirty and fifty, although RA affects all ages. […] For all of these reasons, patients with RA often look to Complementary and Alternative Medicine (CAM) for additional sources of relief. […] Below is an outline of the currently available research for treatments that are commonly used by RA patients, as well as a synopsis of what may be recommended as safe and possibly effective for this population. […] In a report by the National Center for Complementary and Alternative Medicine (NCCAM) within the National Institutes of Health (NIH), it was concluded that evidence for the use of fish oil (or other omega-3 supplements) for the treatment of RA is promising, as a result of several laboratory, animal and clinical studies. […] A 2000 review by the diligent and reputable Cochrane Collaboration investigated several RCTs that suggested a beneficial effect for pain, joint tenderness and morning stiffness. […] While these supplements have shown anti-inflammatory effects in animals, clinical trials have only been conducted in OA. […] Tumeric, which contains circumin, has been associated with decreased inflammation in animals, and one small, double-blind crossover trial found improvements in walking time, swelling and morning stiffness in RA. […] Several European trials have examined the efficacy of vegan (no animal products at all) or vegetarian (includes eggs and dairy) diets for RA patients, sometimes following a period of fasting. These trials have shown some benefits, including less inflammation, lower disease activity, reduced pain and stiffness. […] One RCT of a Mediterranean diet found improvements to clinical and psychological parameters in patients with RA.
#33 Rheumatoid Arthritis: Symptoms, Diagnosis, and Treatment | Arthritis Foundation
https://www.arthritis.org/diseases/rheumatoid-arthritis
Rheumatoid arthritis (RA) causes joint inflammation and pain. […] The goals of RA treatment are to: […] To meet these goals, the doctor will follow these strategies: […] Search arthritis.org to learn about medications your doctor prescribes for your rheumatoid arthritis. […] Working with your doctor to ensure you get appropriate medical treatment is essential, but you can also take measures on your own to manage your RA and ease pain and fatigue. […] Studies show that curcumin/turmeric and omega-3 fish oil supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and how it may affect other medicines you are taking.
#34 Rheumatoid arthritis – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
Better medicines to treat rheumatoid arthritis have lowered the need for surgery. But if medicines fail to prevent or slow joint damage, you and your healthcare professional may think about surgery for damaged joints. […] Rheumatoid arthritis surgery may involve replacing or repairing a damaged joint. The type of surgery may depend on the joint involved. Surgery may help you use a joint again. It also can ease pain.
#35 Rheumatoid Arthritis : Complementary and Alternative Medicine Options
https://www.hopkinsarthritis.org/patient-corner/disease-management/ra-complementary-alternative-medicine/
Complementary and alternative medicine is a very broad category, including mind-body therapies, herbs, energy medicine, and any other modalities that are not considered part of standard allopathic care. […] Some natural supplements have been known for their anti-inflammatory properties, and when side effects are of little concern, they may be beneficial for this population. […] Overall, CAM methods that help patients to relax and balance physical/emotional stress can be beneficial by a variety of mechanisms. […] A variety of lifestyle recommendations are generally accepted for ongoing management of rheumatoid arthritis. These include: 1) eating a healthy, balanced diet for adequate nutrition; 2) participating in regular physical activity; 3) reducing sources of stress and finding ways to better manage stress; 4) relying on sources of social support; 5) openly communicating with care providers; and 6) taking an active role in disease management.
#36 Patient education: Rheumatoid arthritis treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics
The type of drugs that your doctor recommends will depend on how severe your RA is, how well you respond to the medications, and what drugs are available to you. […] Vaccinations are often highly recommended for those with RA, including coronavirus disease 2019 (COVID-19), pneumonia, shingles, and flu vaccinations. […] In some cases, surgery is recommended to improve pain and function in people with end-stage RA. […] Many complementary and alternative therapies have been marketed for the treatment of rheumatoid arthritis (RA). While some approaches may be helpful in certain situations, they should not be used in place of standard medical treatment, and evidence supporting many of these therapies is limited. […] Some of the medications used to treat rheumatoid arthritis (RA) are not safe to take during pregnancy.
#37 Patient education: Rheumatoid arthritis treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics/print
Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may be recommended to relieve pain and reduce minor inflammation. […] Steroids may also be used to treat flares of disease while a person is receiving other treatments. […] Flares are periods in which RA symptoms temporarily worsen; these can occur in addition to the ongoing inflammation. […] The type of drugs that your doctor recommends will depend on how severe your RA is, how well you respond to the medications, and what drugs are available to you. […] The best way to prevent infections is through vaccinations, and that is why vaccinations are often highly recommended for those with RA, including coronavirus disease 2019 (COVID-19), pneumonia, shingles, and flu vaccinations. […] In some cases, surgery is recommended to improve pain and function in people with end-stage RA.
#38 Rheumatoid Arthritis (RA) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Considerations for Specific Patient Presentations
https://emedicine.medscape.com/article/331715-treatment
In terms of frequency of remissions and time to onset of action, MTX and SSZ are the most active compounds and provide the best risk-benefit ratios. MTX, either alone or in combination with other agents, has become the standard of care for moderate to severe RA. […] Triple therapy MTX, SSZ, and HCQ may provide greater improvement in disease activity compared with MTX monotherapy, but has the disadvantages of less convenience and greater cost. […] Biologic agents are expensive. Consensus statements do not recommend their use until at least one nonbiologic DMARD, usually MTX, has been administered without sufficient success. […] Patients taking anti-TNF agents must avoid live-virus vaccines. […] Corticosteroids are potent anti-inflammatory drugs that are commonly used in patients with RA to bridge the time until treatment with DMARDs is effective.
#39 Newest Treatments for Rheumatoid Arthritis Pain
https://www.verywellhealth.com/new-rheumatoid-arthritis-treatment-5221441
The newest drugs and treatments for rheumatoid arthritis (RA) include Janus kinase (JAK) inhibitors, a Brutons tyrosine kinase (BTK) inhibitor, and neurostimulation, among other treatments. […] While there’s currently no cure for the disease, researchers have identified new and experimental therapies that can help lessen symptoms and minimize joint damage. […] JAK inhibitors are some of the newest treatments to gain FDA approval for RA. These medications are DMARDS (disease-modifying antirheumatic drugs) that come in pill form and help stop a person’s immune system from producing certain enzymes that can stimulate inflammation. […] Researchers are studying an experimental medicine called fenebrutinib, which blocks the action of Brutons tyrosine kinase (BTK), an enzyme that promotes inflammation in the body.
#40 Newest Treatments for Rheumatoid Arthritis Pain
https://www.verywellhealth.com/new-rheumatoid-arthritis-treatment-5221441
Biologics are a subset of DMARDs that are made in living cells. […] Sarilumab (Kevzara), is the newest IL-6 inhibitor to be approved by the FDA to treat RA. […] Researchers are studying the potential of vagus nerve stimulation, a treatment that uses electrical impulses to stimulate the vagus nerve, which runs from the brain stem to the stomach. […] In recent years, several clinical trials have been conducted to test supplements as possible treatments for RA. […] Several other treatments are on the horizon for RA. […] Mesenchymal stem cell (MSC) therapy is being studied as a promising treatment for RA because of its potential to slow progression of RA, repair and regenerate damaged joints and tissues, and reduce pain and swelling. […] Today, people with RA have many newer options, including disease modifying anti-rheumatic drugs (DMARDS), biologic agents, and JAK inhibitors. […] JAK inhibitors, BTK inhibitors, biologics, vagus nerve stimulation, stem cells, and vaccines are some novel treatments being explored.
#41 New hope for treating rheumatoid arthritis | University of California
https://www.universityofcalifornia.edu/news/new-hope-treating-rheumatoid-arthritis
A team led by engineers at the University of California San Diego has developed a biodegradable polymer system to treat rheumatoid arthritis, an autoimmune and inflammatory disease, by working in concert with the power of the human immune system. […] With this method, encapsulated ATRA is injected directly into a joint affected by rheumatoid arthritis, where it remains in effect for at least several weeks. […] Essentially, our system turns the disease site into a factory that produces regulatory T cells. […] This is a very promising line of research utilizing the latest and greatest technology in immunoengineering to combat arthritis. […] ATRA has potential in treating autoimmune arthritis, but the route of administration precluded the work from being relevant to clinical translation.
#42 New hope for treating rheumatoid arthritis | University of California
https://www.universityofcalifornia.edu/news/new-hope-treating-rheumatoid-arthritis
When ATRA is encapsulated using biodegradable materials, it can be injected directly into joints at therapeutic concentrations but as it diffuses out of the joint, it enters circulation at much lower concentrations, minimizing or preventing unwanted effects. […] Time-released ATRA reprograms them to act as regulatory T cells, or good apples. […] ATRA makes lasting modifications to the ability of cellular machinery to read cell DNA, improving the function of the anti-inflammatory regulatory T cells. […] If you can instead have a treatment option that doesn’t have an immunosuppressive effect, you can really reduce the risk for patients that need multiple treatment modalities to keep their autoimmune disease in check. […] New treatments like this one could potentially supplement DMARDs, compensating for waning effectiveness or requiring lower doses to start with. […] However, when it is attempted, studies have shown that the disease can flare up again. So having a non-immunosuppressive option could go a long way.