Managing Rheumatoid Arthritis

Rheumatoid arthritis (RA) affects 1.3 million Americans. Treatment programs are tailored to meet each individual's needs, taking into account the severity of the condition, other medical problems, and the person's lifestyle.

Managing rheumatoid arthritis

The symptoms of RA include pain, stiffness, warmth, redness, and swelling of the affected joints. The symptoms can come and go. The treatment goals include reducing joint swelling, relieving stiffness, preventing joint damage, and maintaining joint function.

There is no cure for RA, but many drugs are available to manage the pain and slow the progression of this disease. New medications may help prevent damage to the joints by reducing inflammation.

Most people with RA take several medications, including nonsteroidal anti-inflammatory drugs and corticosteroids to help reduce joint pain, stiffness, and swelling. Other medications often prescribed, like methotrexate, are called disease-modifying antirheumatic drugs, which slow the progression of RA. Also, drugs called biologic response modifiers (or "biologics"), which block inflammation, may be prescribed. These include abatacept, adalimumab, etanercept, infliximab, golimumab, and rituximab.

Treatment also includes a combination of exercise, rest, stress reduction, joint protection, hot/cold therapy, and physical and occupational therapy. Surgery, including joint replacement, can also reduce pain and improve the function of damaged joints. 

Being proactive

The following guidelines from the Arthritis Foundation can help you work with your doctor to find the best treatment:

• Folic acid. If you take methotrexate, your doctor also should prescribe a folate supplement to help reduce the drug's side effects.

• Calcium and vitamin D supplements. RA can cause a generalized bone loss that may lead to osteoporosis, particularly if you take corticosteroids.

• Exercise. If you can work out, your doctor should prescribe a supervised muscle-strengthening or aerobic exercise program and should review it with you at least once a year.

• Assistive devices. If you're having difficulty walking, your doctor should evaluate you to determine whether you need any assistive devices, such as a cane, insoles, or orthotics. Likewise, if you're having difficulty with daily living tasks, such as brushing your teeth or dressing, your doctor or a therapist should evaluate you to determine whether you need assistive devices to help with the tasks, or splints for your hands or wrists.

• Vaccines. If you're taking immunosuppressant therapy and/or steroid therapy, you should not receive vaccines containing live viruses or bacteria. Most other vaccines are safe to get, including an annual influenza (flu) vaccine. 

• TB. If your doctor has discussed giving you one of the new biologic response modifiers such as infliximab, you should be tested for tuberculosis (TB), which may include getting a chest X-ray before starting treatment. If you had a positive TB test in the past, let your doctor know.

• Alcohol. Many of the drugs used to treat RA can affect the liver. Drinking alcoholic beverages increases the likelihood of liver damage. Check with your doctor to see what amount of drinking, if any, is safe.