The treatment options for this chronic, inflammatory type of arthritis are ever-evolving.
Rheumatoid arthritis (RA) affects approximately 1.5 million people in the United States, or about 0.6% of the population. It is a progressive condition that, without proper treatment, can worsen over time.
In recent years, researchers have made considerable progress with new treatments that help relieve RA symptoms and slow the progression of the disease. They may even be closer to eventually finding a cure.
Two board certified rheumatologists with Texas Orthopedics in Austin, Dr. Robert Koval and Dr. Joseph Martinez, weigh in on how RA management and treatment have evolved in recent years. They also discuss what is to come.
The medications and therapies for treating RA continue to evolve. Scientists are regularly testing new treatments to provide more effective options, help more people find symptom relief, and prevent disease progression.
Doctors have used traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, to treat RA for decades. These drugs work by suppressing the overactive immune system as a whole.
Biologics, a newer option, are a targeted type of DMARD. Available as injections or intravenous infusions, these drugs work by targeting specific parts of the immune system to block inflammation.
The newest RA drugs to gain Food and Drug Administration (FDA) approval are called Janus kinase (JAK) inhibitors. They work by blocking a very specific pathway to stop a person’s immune system from creating certain enzymes that can lead to RA. These medications come in pill form, and people can use them in combination with some other RA drugs.
“At this time, we are fortunate to have several safe and effective treatments for RA. Among the newest include the family of therapies known as JAK inhibitors,” said Dr. Martinez. “In the U.S., there are currently three approved JAK inhibitors for treating RA.”
According to Dr. Koval, “Upacitinib (Rinvoq) is a relatively new JAK inhibitor, which has shown good success in head-to-head trials versus other well-established biologic drugs.”
He went on to state that “JAK inhibitors have been around a while now, and I have definitely had success using these with many patients.”
Dr. Martinez also indicated that he has found the use of JAK inhibitors to be an effective treatment option for many of his patients.
“The drugs differ based on which specific JAK molecules they inhibit, and we have yet to identify which target is superior,” added Dr. Koval.
He also explained that “there are many new mechanisms of action being studied right now that have the potential to change the RA treatment landscape as well.” In other words, people with RA may start to see some newer, possibly even more effective, JAK inhibitor treatments in the not-too-distant future.
As more treatment options become available, doctors can recommend individualized approaches and interventions.
“Developing a treatment plan must be individualized to every patient with RA,” explained Dr. Martinez.
“Treatment strategies remain extremely individualized based on patient desires, characteristics, and comorbidities,” added Dr. Koval.
“With so much research and funding currently available on this topic, rheumatologists must constantly analyze the data and keep up to date on the latest developments,” said Dr. Koval.
He went on to state, “We can identify which therapies perhaps work better than others. We are also able to identify certain side effects or nuances with certain drugs that make them more or less appropriate for individual patients.”
Dr. Koval went on to further explain, “Current research has provided evidence for [the] use of additional treatment options when first-line pharmacologic agents prove inadequate for a patient. In these circumstances, using a treatment that affects different biologic pathways has shown to be an effective approach in my clinical practice.”
Currently, there is no cure for RA. Doctors use the latest treatments to help people with RA manage their symptoms and prevent the disease from progressing.
When asked about the possibility of a cure, Dr. Koval indicated a positive outlook. “Seeing how far we have come with RA in just the [past] 30 years, it makes me encouraged that we will one day find a cure. Science and technology [have] advanced considerably in this field, and I am excited at what the future may bring.”
Dr. Martinez felt more cautiously optimistic. “It is not clear if or when we will have a ‘cure’ for RA,” he stated. “There is significant research going on to better help us understand the causes and mechanisms that lead to RA, perhaps helping us reach that lofty goal in the future.”
Even without a cure on the immediate horizon, it is possible to achieve
In addition to medications, people with RA often seek natural or home remedies to help alleviate their symptoms.
“Patients will try many different ‘natural’ modalities to help with pain,” said Dr. Koval, who often encourages trying therapies outside of the normal medical scope.
“Various supplements, including turmeric, omega-3s, and CBD oil, have shown some success,” said Dr. Koval.
Dr. Martinez also explained that “regular low impact exercise can be important for strengthening the joint and maintaining good range of motion, which can be very helpful in RA.”
Dr. Koval added that his patients often use “light exercise such as yoga or Pilates, combined with a regular stretching routine,” to help with pain management.
The use of exercise to help with RA symptoms, such as pain and stiff joints, is well-known. In an
Dr. Koval also recommended “behavioral or cognitive therapy for those who may benefit from it.”
Researchers are constantly looking for new and improved ways to treat and manage RA. People with RA should talk with a doctor about their options.
Although there is currently no cure for RA, there is hope. The goal of treatment is to relieve symptoms and prevent the progression of the disease. It may even be possible to enter remission.