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Rheumatoid arthritis is an autoimmune inflammatory arthritis. The word "auto" means self, so these are diseases in which the immune system attacks itself. Normally your immune system is not supposed to do that. It's supposed to attack viruses, bacteria, fight off infections, but in some people for whatever reason their immune system gets confused and attacks its own tissues. In the case of rheumatoid arthritis the immune system makes inflammation, the inflammation runs through the body and settles into certain areas, especially into the joints, and if it settles into those joints it can cause pain, swelling, stiffness, and over time that swelling has chemicals, which can cause destruction of bone underneath it, leading to deformity and disability.

Once a diagnosis of rheumatoid arthritis is made, depending on the severity we decide on the treatment path. Traditionally we use two groups of medications, the disease modifying medications referred to as DMARDS, and the biologic medications. Traditionally we start with a DMARD if the symptoms are relatively mild. If on the other hand the symptoms are more severe, we may start with a biologic medication. Oftentimes we find ourselves combining various combinations of these medications to get adequate control of the disease.

Disease modifying medications or DMARDS have been on the market for many years. They're oral medications that act on the immune system in a more general way. They act on overactive immune processes, whereas biologic medications, this newer group of medications, is much more specific targeted therapy.

One of the most important properties of our immune system is to make inflammation. Say for example you get a cut or a wound. It's your immune system that detects the danger and makes inflammation. Inflammation is made by a group of proteins referred to as cytokines. These are signaling proteins.They tell cells to make inflammation.

Some of the newer treatments referred to as biologic medications target specific pro-inflammatory cytokines. By preventing or inhibiting these inflammatory cytokines, inflammation is prevented from being made.

The majority of our patients actually are on various combinations of medications and to adequately control our patients oftentimes we combine these medications. Occasionally we get lucky. We find a patient that may be in the early stages or has very mild disease or has a great response to just an oral disease modifying medication. This happens in about a third of our patients, however two-thirds of our patients require various combinations of disease modifying medications or disease modifying medications plus a biologic.

Oftentimes we will often cycle through various biologics. If one biologic doesn't work, we may swap it out for another one to achieve better control of the disease.

If a patient has persistent joint pain, stiffness, or swelling, then they are most likely failing their current therapy. On the other hand, at times patients feel that their symptoms are adequately controlled, however there are certain objective measures that the rheumatologist monitors, and if those objective measures such as blood work, ultrasound, x-rays are showing persistent disease activity, then also we consider that the patient is failing current therapy. In either situation we try to dose adjust these patients or change medications to get better control of their disease process.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic disorder that involves inflammation of the lining of the joints. It typically starts in the small joints of the hands, and causes pain, redness, and swelling. RA is an autoimmune disease, which means the body’s own immune system attacks the joints as if they’re some type of virus or bacteria.

Advancing RA

RA is a progressive disease, which means that symptoms will gradually worsen. As the condition progresses, it may spread to other joints, like the feet, ankles, wrists, elbows, and knees. It may also advance to the joints between the vertebrae in the spine, and even affect major organs like the skin, heart, and kidneys.

Even though there’s no cure for RA, it’s a manageable and treatable disease.

Managing the Progression

The goal of treatment is to slow the progression of RA and treat the symptoms. Healthcare providers typically use a combination approach of drug treatment, reducing stress on the joints, and physical therapy. In some cases, surgery may be necessary.

RA Drugs


The first line of defense against RA is a class of drugs known as DMARDs, or disease-modifying anti-rheumatic drugs. DMARDs, which include newer biologic medications, are very effective, and doctors are now turning to DMARDs as soon as a diagnosis is made. These drugs are a type of anti-inflammatory, so they actually work to change the course of RA, rather than just treating the symptoms.


For acute, “right now” pain and inflammation, over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) may be used. These include household staples like ibuprofen (Advil, Motrin) and naproxen (Aleve).


Drugs like prednisone and cortisone reduce both inflammation and temper the body’s immune response. Corticosteroids are often used as short-term fixes, or during the four to six week period before DMARDs begin to take effect. There are a number of side effects and risks associated with corticosteroids, so some doctors may avoid prescribing them to avoid side effects.

Reducing Joint Stress

The next step in managing the progression of RA is reducing stress on the joints. During a flare-up, when joints are at their most painful, rest is very important. Maintaining a healthy weight will prevent added strain, as carrying even a little bit of extra weight greatly increases stress on the joints. If walking is difficult, using a cane or walker can take some of the burden off of stressed joints.

Physical Therapy

Regular exercise is very important to joint health. It strengthens muscles around the joints, reduces stress and inflammation, and improves mobility and flexibility. For people with RA, it’s important to stick with low-impact or nonimpact exercise. A physical or occupational therapist can help you come up with a personalized exercise plan geared towards your needs.

Dealing with Side Effects

As RA progresses, complications and side effects can arise. You may experience:

  • skin problems, like rashes, bumps, or ulcers
  • eye problems, like inflammation and dry eyes
  • inflammation of the blood vessels or the membrane around the heart
  • increased risk of heart attack and stroke
  • anemia, or low red blood cell count
  • diseases of the lungs or kidneys
  • fatigue, lack of sleep
  • depression

It’s important to talk to your doctor if you experience these or any other unusual symptoms that could be related to your RA. Side effects like skin and eye problems, anemia, fatigue, and depression are treatable with either medications or lifestyle changes. Other problems involving the heart, lungs, and kidneys need to be caught early, so ask your doctor about regular monitoring of these major organs, especially if you are taking corticosteroids.

As with any disease, your overall health plays a key role in managing your RA, and dealing with side effects and complications. Try to maintain a healthy diet, get plenty of rest and exercise, and stay in open communication with your healthcare providers to manage your RA progression.