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Treatments and drugs
By Mayo Clinic staff
There is no cure for rheumatoid arthritis. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage. Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.
Medications
Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs as your disease progresses.
- NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. Side effects may include ringing in your ears, increased bruising, gastric ulcers, heart problems, stomach bleeding, and liver and kidney damage.
- Steroids. Corticosteroid medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain and slow joint damage. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
- Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Rheumatrex, Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and minocycline (Dynacin, Minocin). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
- Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. Examples include azathioprine (Imuran, Azasan), cyclosporine (Neoral, Sandimmune, Gengraf) and cyclophosphamide (Cytoxan). These medications can increase your susceptibility to infection.
- TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints — usually within one or two weeks after treatment begins. Examples include etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Potential side effects include injection site irritation, congestive heart failure, blood disorders, lymphoma, demyelinating diseases and increased risk of infection.
- Other drugs. Several other rheumatoid arthritis drugs target a variety of inflammatory substances produced by your body. These drugs include anakinra (Kineret), abatacept (Orencia) and rituximab (Rituxan). Potential side effects include injection site reactions, decreased white blood cell counts, headache and an increase in upper respiratory infections.
Therapy
An occupational therapist can help you find different ways to approach everyday tasks in order to take stress off your painful joints. For instance, if your fingers are sore, pick up an object using your forearms. Lean into a glass door to force it open, rather than pushing on the door with sore arms.
Assistive devices can make it easier to go about your day without stressing your painful joints. For instance, using specially designed gripping and grabbing tools may make it easier to work in the kitchen if you have pain in your fingers. Try a cane to help you get around. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you. Catalogs and medical supply stores also may be places to look for ideas.
Surgery
If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. Rheumatoid arthritis surgery may involve one or more of the following procedures:
- Total joint replacement (arthroplasty). During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
- Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
- Removal of the joint lining (synovectomy). If the lining around your joint (synovium) is inflamed and causing pain, your surgeon may recommend removing the lining of the joint.
- Joint fusion (arthrodesis). Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.
Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor.
- Rheumatoid arthritis. American College of Rheumatology. http://www.rheumatology.org/public/factsheets/diseases_and_conditions/ra.asp?aud=pat. Accessed Aug. 25, 2009.
- O'Dell JR. Rheumatoid arthritis. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/156141423-3/0/1492/1022.html#4-u1.0-B978-1-4160-2805-5..50290-1_12843. Accessed Aug. 25, 2009.
- Handout on health: Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Accessed Aug. 25, 2009.
- Hunder GG. Mayo Clinic Straight Talk on Arthritis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2006.
- Rheumatoid arthritis and complementary and alternative medicine. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/RA/. Accessed Aug. 26, 2009.
