Rheumatoid arthritis (RA) treatment takes many forms. Some medications can improve symptoms, while others can slow disease progression. Reducing joint stress can also help. In severe cases of RA, when other interventions fail, doctors may recommend surgery.

Medications for RA aim to reduce pain and inflammation and limit or prevent joint damage.

This article examines RA treatments, including medication, joint stress reduction, surgery, and home management strategies. The article also examines the treatment options for RA during pregnancy.

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There is no cure for RA. However, treatment can improve the quality of life of people with RA.

Treatment aims to:

  • provide long-term elimination of RA signs and symptoms, or achieve remission
  • maintain remission
  • minimize joint damage

DMARDs are typically the first drugs that doctors prescribe to treat RA. When functioning properly, DMARDs can mitigate joint destruction and deformity.

There are different types of DMARDs, including:

  • synthetic DMARDs
  • biological therapies, such as tumor necrosis factor (TNF) inhibitors
  • targeted synthetic DMARDs, such as JAK inhibitors

Synthetic DMARDs

Synthetic DMARDs are medications that suppress the immune system and reduce inflammation.

Examples include:

Biological DMARDs

Biological DMARDs are a newer class of medication. They help to prevent inflammation by stopping certain cells in the immune system.

TNF inhibitors are a type of biologic DMARD. They help to reduce the level of TNF in the body. TNF is a protein in the body that can cause inflammation.

According to VersusArthritis, a UK nonprofit, doctors typically prescribe TNF inhibitors if other treatments are ineffective. A doctor will prescribe TNF inhibitors in combination with conventional DMARDs, such as methotrexate.

TNF inhibitors include:

Other biological therapies include:

Targeted synthetic DMARDs

JAK inhibitors are an example of targeted synthetic DMARDs. They block enzymes called Janus Kinase, which are involved in inflammation that cause the symptoms of RA.

Examples include:

Risks, side effects, and considerations

Many of these medications have side effects, for example:

  • Methotrexate can lead to bone-marrow problems and liver problems.
  • Hydroxychloroquine can cause gastrointestinal, skin, and central nervous system (CNS) problems.
  • Sulfasalazine can lead to gastrointestinal problems, problems with the CNS, and rashes.

There are many different RA medications that work in different ways in different people, cause a range of different side effects, and vary in cost. For example, TNF inhibitors can be highly effective but tend to be expensive. Before starting RA treatment, talk with a doctor about which option is best.

Learn about the differences between traditional and biologic DMARDs.

NSAIDs can provide relief from pain and inflammation. NSAIDs are available to purchase over the counter. However, if a person requires higher doses, a doctor can prescribe them. To find the best dose for them, a person should speak with a doctor.

A doctor may prescribe the following NSAIDs:

A 2019 article notes that aspirin is an older NSAID that effectively reduces inflammation when a person takes high doses. The other NSAIDs are newer, just as effective, and need fewer doses to be effective.

Risks, side effects, and considerations

NSAIDs can cause the following side effects:

Using NSAIDs long term can also cause problems with the heart, kidneys, liver, and blood circulation.

A person may choose to take NSAIDs with food, milk, or a milk alternative to help protect the stomach. A doctor may also prescribe a proton-pump inhibitor to protect the stomach.

Learn more about NSAID strengths.

Corticosteroids are stronger than NSAIDs and have more significant side effects. For this reason, doctors typically prescribe corticosteroids at low doses and for a limited time.

A doctor may also inject corticosteroids into the painful joint.

Risks, side effects, and considerations

Corticosteroids can cause significant side effects, including:

Learn more about corticosteroids for RA.

RA causes inflammation and damage to the joints in the hands, wrists, and knees. Any stress on the joints could worsen symptoms of RA, such as increasing pain and joint damage.

The Centres for Disease Control and Prevention (CDC) recommend that people with any type of arthritis, including RA, do the following:

  • achieve and maintain a moderate weight and BMI
  • take part in regular physical activity
  • avoid injuring the joints

Maintaining a moderate weight and an exercise routine is not always easy. Getting advice from a healthcare professional about how to safely manage body weight for RA may help.

Learn about 9 exercises to ease RA pain here.

According to a 2019 review, doctors recommend surgery as a last resort. Doctors only advise surgery for stage 4, or end stage RA. At this point, joint pain or dysfunction is severe and unresponsive to medication.

There are several surgical interventions for RA, including tendon repair, joint fusions, and bone realignment. These interventions aim to repair joints and surrounding tissues. Surgeons may also introduce artificial implants.

In some cases, doctors will recommend a total joint replacement. This involves removing a damaged joint and replacing it with a prosthetic.

Learn about surgery for arthritis.

Research suggests that some lifestyle choices could make it easier to manage RA symptoms.

For instance, diet could affect RA. Although scientists do not think any foods adversely affect RA, some dietary choices could improve it. These include diets that are rich in the following:

Learn more about an RA diet.

Both physical and occupational therapy can improve the symptoms of RA. Exercise could also help by improving joint mobility and strength. Certain low impact exercises may be especially beneficial. These include:

Some home interventions for RA could also help prevent RA complications.

For example, a study in the Journal of Clinical Medicine states that people with RA are at an increased risk of coronary atherosclerosis.

However, people with RA can reduce this risk by maintaining a moderate weight and avoiding high blood pressure. Exercise can help with both.

Learn more about the best home remedies for arthritis, including RA.

There is evidence that some RA medications can cause complications during pregnancy, affecting the pregnant individual, the child, or both.

For example, taking NSAIDs during the third trimester could cause premature closure of the ductus arteriosus, a blood vessel in a fetus that should only close after birth.

However, there are some medications for RA that a pregnant person can take under the guidance of a healthcare professional.

Anyone with RA should seek medical advice about their treatment during pregnancy.

Learn more about RA and pregnancy.

There are many RA treatment options, but medication remains the first line of treatment for many doctors.

Some medications can help with symptoms of RA, such as pain and swelling. Others can help to slow disease progression by preventing joint damage.

However, while these medications typically have significant benefits, they can also have serious side effects, and some medications are unsafe during pregnancy.

Maintaining a moderate weight can help lower joint stress and reduce pain and joint damage. Home management strategies include regular, low impact exercise and specific dietary choices.

Surgery is usually a last resort.