Rheumatoid Arthritis Treatment

Many biologics block TNF, a chemical your body makes that causes inflammation. Other biologics target other chemicals -- like IL-1 or IL-17.

Biosimilar drugs are now available for some of these biologics. These are close copycats of the original drugs, made with the same types of living materials. You get them the same ways and they're proven to be as effective and safe as the biologics at the same dosage. A biosimilar may cost you less, but it can depend on your insurance. You should talk with your doctor about the pros and cons of switching from a biologic to a biosimilar drug.

Some of the biologic and biosimilar drugs available to treat RA include:

Biologic rheumatoid arthritis drugs 

• Abatacept (Orencia)
• Adalimumab (Humira)
• Anakinra (Kineret)
• Certolizumab (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi, Simponi Aria)
• Infliximab (Remicade)
• Rituximab (Rituxan)
• Sarilumab (Kevzara)
• Tocilizumab (Actemra)

Biosimilar rheumatoid arthritis drugs

For adalimumab:

• Adalimumab-adaz (Hyrimoz)
• Adalimumab-adbm (Cyltezo)
• adalimumab-afzb (Abrilada) 
• Adalimumab-atto (Amjevita)
• Adalimumab-bwwd (Hadlima)
• Adalimumab-fkjp (Hulio)

For etanercept:

• Etanercept-szzs (Erelzi)
• Etanercept-ykro (Eticovo)

Combination therapy

Taking more than one medication might help you move better with less pain. It could also slow or stop joint damage, though it can't reverse damage you already have.

You'll probably take methotrexate as part of combination therapy, plus a similar drug (such as hydroxychloroquine, leflunomide, or sulfasalazine), or a biologic. In some cases, you might get two biologic drugs.

Combination therapy side effects. With combination therapy, you might get side effects from each of the drugs you take. In some cases, a combination might increase side effects,  For example, if you take two biologics, you might have a higher risk of infection, especially if your overall dose of medicine increases.

Surgery for Rheumatoid Arthritis

If joint pain and inflammation become unbearable or joints are severely damaged, you might need surgery to replace or repair joints. Some surgeries earlier in the course of RA might help limit joint damage. But because modern drugs work well for many people, surgery is less common than in the past.

Joint replacement surgery

The hips and knees, and sometimes the shoulders, are the most common joints replaced. Some joints, such as the ankles, don't respond well to artificial replacement. 

Important to know: While doctors long estimated that replacement joints might start to wear down in as little as 10 to 15 years, more recent research suggests today's joints last longer. But individual results can vary.

Other rheumatoid arthritis surgeries

Your doctor also may recommend surgeries such as:

Synovectomy. This is surgery to remove the inflamed lining of a joint, called the synovium. It's most often used in early stages of rheumatoid arthritis for fingers, wrists, elbows, knees, and hips.

Tenosynovectomy. This is surgery to remove inflamed tissues around tendons, typically in the hand and wrist.

Tendon repairs or transfers. When tendons around a joint loosen or rupture, also typically in the hands, a surgeon may be able to repair them. Or they may move a functioning tendon to the damaged area to improve strength and stability. This is called a tendon transfer or realignment.   

Arthrodesis. This surgery, also called joint fusion,  joins together two bones in a joint. That can increase stability and reduce pain. It's commonly used in the spine, foot, and ankle. 

Talk about your surgical options with your doctor. You may want to ask:

• What are the pros and cons?
• What are the possible complications?
• How long will it take to recover?
• Will I need physical therapy?
• How long will the results last?

Physical and Occupational Therapy

Physical therapy and occupational therapy are key parts of any rheumatoid arthritis treatment plan.

Physical therapists can give you an exercise plan, teach you how to use heat and ice, do therapeutic massage, and encourage and motivate you.

Occupational therapists help you handle daily tasks -- like cooking or using your computer -- and show you easier ways to do those things. They can recommend any gadgets that might help you. 

CBT Treatment for Rheumatoid Arthritis

Because one of the most trying aspects of rheumatoid arthritis is learning to live with pain, many doctors recommend pain management training. They may call it cognitive behavioral therapy or CBT.

The goal is to improve your emotional and psychological well-being as you develop ways to relax, handle stress, and pace yourself. For instance, you might try guided imagery, relaxation, distraction, and creative problem-solving.

Exercising With Rheumatoid Arthritis

When your joints are stiff and painful, exercise might be the last thing on your mind. But exercising regularly is one of the best things you can do.

It may help you:

• Live longer
• Have less  pain
• Have stronger bones -- especially crucial if you take bone-thinning steroid drugs 
• Have stronger muscles so you move better despite RA
• Lift your mood
• Have more energy

There may be days when you have a lot of symptoms, so you need to rest more and exercise less. Work to find a balance and be as active as you can on better days.

Alternative Rheumatoid Arthritis Treatments

Many alternative or complementary therapies for rheumatoid arthritis lack the strong scientific evidence that supports standard medical approaches. If you want to try them, talk to your doctor about which ones might work with your treatment plan. 

These are some possible approaches. 

Acupuncture. Some people report that acupuncture -- in which key points in the body are stimulated with needles -- eases their pain. But studies have been limited and haven't shown clear benefits. 

Mind/body therapy. Mind/body therapies may help you manage stress, sleep better, and react differently to pain. Strategies include deep belly breathing, relaxing your muscles one by one from head to toe, visualization (such as picturing a calming scene), meditation, and tai chi.

Biofeedback. This is a strategy for handling your pain. You work with a therapist who helps you recognize when you feel tense and learn ways to calm yourself. 

Electrical stimulation (TENS).  TENS is a small device that sends electrical signals through electrodes placed on your skin near the area that hurts. It might interrupt pain signals or trigger the release of natural painkillers called endorphins. But evidence that it works for rheumatoid arthritis pain is lacking. 

Nutritional supplements. If you are considering any supplement for your rheumatoid arthritis, talk to your doctor. Some might interfere with your medications or have other serious side effects. Research on most nutritional supplements used for rheumatoid arthritis is too skimpy to reach any conclusions about usefulness. But there is evidence that omega-3 fatty acids in fish oil may help ease inflammation and RA pain. An herb called thunder god vine has shown some promise, but it can have serious side effects, so risks may exceed any benefits.

Natural Treatments for Rheumatoid Arthritis

There are some additional nondrug treatments and lifestyle changes that might help with your RA when added to your medications and other therapies.

Heat and cold. Ice packs can reduce joint swelling and inflammation. Put a cold compress or ice pack (wrapped in a towel) on the joint. Use the ice packs for 15 minutes at a time, with 30-minute breaks in between.

Hot compresses relax muscles and stimulate blood flow. Wrap a warm towel or pad around the area that hurts. Or try a warm bath or shower.

Capsaicin. It's an ingredient in hot peppers. Studies show that it can ease pain when you rub your joints with cream that's got some in it. You may feel more pain at first, but it usually eases up.

Better sleep. To get enough sleep, go to bed and get up at the same time each day. Get some exercise during the day and limit caffeine and alcohol.

Not smoking. If you smoke, make it a priority to quit, and ask your doctor for help. If you keep smoking, it may make your RA treatment less effective.

Can I Cut Back on My RA Medications if I Feel OK?

If pain and stiffness start to fade, you may wonder if you can take less medication.

RA is a long-term condition, and medicine keeps your symptoms under control. Studies show that people who stop their RA medicine are likely to have a flare of symptoms 4 to 8 weeks later. If your disease stays active, you're more likely to get permanent joint damage.

 But with guidance from your doctor, you might be able to cut back in some circumstances. Expect your doctor to ask:

When was your last flare?

Your doctor will want to know how long it's been since you had any problems. They'll also do some tests. If everything looks good, your doctor may slowly lower the dose of your medications.

Do you have any trouble with side effects?

Your doctor may be able to adjust your medicine or how you take it. For example, many drugs used to treat RA can cause an upset stomach. To help, your doctor may suggest taking it at a different time or with food. They may also recommend medication to ease nausea and help with stomach acid.

Rheumatoid Arthritis Prevention

You can't control some of the major risk factors for rheumatoid arthritis, like your family history, your genes, or getting older.

But studies suggest that you might be able to lower your risk by avoiding:

• Smoking, which not only increases your risk of RA, but can make it more severe
• Obesity, which also can make RA harder to control
• Gum disease
• Exposure to air pollution 

Takeaways

There's no cure for rheumatoid arthritis, but with today's medications and other therapies, you can get your symptoms under better control and limit joint damage. Getting enough exercise and sleep and learning ways to minimize and cope with pain can help, too. Work with your doctor to find the best treatment plan for you.

Rheumatoid Arthritis Treatment FAQs

How do you diagnose rheumatoid arthritis?

Joints that are swollen, red, and warm are a sign of rheumatoid arthritis. Morning stiffness is another clue. But there's no single blood test or physical finding that confirms the diagnosis. Your doctor may use the results of several blood tests, plus your symptoms, how your joints feel, and how they look on imaging tests like X-rays, to come to a diagnosis. 

What is the best thing to do if you have rheumatoid arthritis?

The best thing you can do is to get a diagnosis and start treatment as early as possible, since joint damage can't be reversed. Once you have a treatment plan, it's important to stick to it and to follow your doctor's advice on a healthy lifestyle. 

What is the life expectancy of someone with rheumatoid arthritis?

Past research has suggested that people with rheumatoid arthritis die about 10 years sooner than average. Complications such as lung and heart problems may be to blame. But newer treatments seem to be improving lifespans.

What's the worst thing that can happen with rheumatoid arthritis?

In advanced stages, your damaged joints can be severely painful, swollen, and stiff, and you can have a lot of trouble moving around. The inflammation in your body can also damage your skin, eyes, mouth, lungs, and heart. Early treatment can help head off these complications.