Rheumatoid arthritis (RA) doesn’t follow one exact timeline, so it affects everyone differently. However, learning about RA symptoms and treatment options can help you understand what to expect and make informed decisions to slow disease progression.
Rheumatoid arthritis (RA) is a chronic disease that affects the joints. More than 1.5 million people in the United States have received a diagnosis of RA. Of these individuals, about 75% are women. It can occur at any age, but it’s most often diagnosed between the ages of 30 and 50.
Language matters
We use “women” and “men” in this article to reflect the terms that have been historically used to gender people. But your gender identity may not align with how your body responds to this disease. Your doctor can better help you understand how your specific circumstances will translate into diagnosis, symptoms, and treatment.
RA is an autoimmune disorder, which it isn’t the same as other types of “wear and tear” arthritis like osteoarthritis. With RA, the body’s own immune system mistakenly attacks the tissue lining the joints (synovium). This leads to inflammation, which causes joint pain, stiffness, and swelling.
Over time, the affected joints become increasingly dysfunctional. If left untreated, RA can result in permanent joint damage.
Modern drug treatments have greatly improved the chances that a person with RA will be able to lead a healthy and relatively normal life, and prevent progressive damage.
The symptoms of RA vary from person to person but commonly include:
- joint pain
- joint stiffness, particularly in the morning
- joint swelling
- persistent fatigue
- weakness
RA can affect any joint, but the small joints in the hands and feet are most often affected. Symptoms typically affect multiple joints, and often be similar on both sides of the body (symmetric).
RA symptoms are also typically marked by periods of disease activity, known as flares, followed by periods of disease inactivity or remission.
There’s no single test for helping diagnose RA. Your doctor will likely:
- Ask about your symptoms.
- Review your medical history.
- Perform a physical examination.
- Request blood work.
- Arrange imaging tests like an X-ray or MRI.
You may meet with an arthritis specialist called a rheumatologist for testing and treatment.
It may take time to diagnose RA in its early stages as many of its symptoms mimic other conditions. However, because RA can progress rapidly, early diagnosis and treatment are important.
As a progressive disease, RA is classified based on its stages or severity of symptoms and disability. Knowing the stage of your disease, as well as how fast the condition is progressing, can help your doctor determine the best treatment plan.
- Stage 1: minimal symptoms and no X-ray evidence of destructive changes in the joints
- Stage 2: more present symptoms as well as X-ray evidence of slight bone or joint damage (but no joint deformity)
- Stage 3: more severe symptoms as well as X-ray evidence of cartilage and bone destruction along with joint deformity
- Stage 4: everything in stage 3 as well as presence of joint fusion, making it difficult to perform normal activities
Fortunately, due to modern medical advances, a person with RA is unlikely to reach stage 4 if treatment is started early.
If you start to experience any new or worsening symptoms, despite following your RA treatment plan as prescribed, this could be a sign your RA is progressing. Check in with your doctor right away. You may need to re-evaluate your treatment regimen and adjust the dosage, add a new drug, or make a treatment switch.
RA affects everyone differently, so treatment will also vary from person to person. Starting treatment early can help slow progression, improve long-term outcomes, and promote a better quality of life.
A variety of treatment options are available for RA. It’s important to work with your doctor to determine which medication, or combination of treatments, is best for you.
Nonsteroidal anti-inflammatory (NSAID) drugs
NSAIDs provide symptomatic relief from pain and inflammation, but they don’t alter the progression of the disease. They may also pose some risk for heart and stroke issues.
This class of drugs includes over-the-counter (OTC) medications and prescription COX-2 inhibitor drugs. OTC options of NSAIDs include:
- ibuprofen (Advil, Motrin IB, Nuprin)
- naproxen sodium (Aleve)
Prescription NSAIDs options include:
- celecoxib (Celebrex)
- ibuprofen (prescription-strength)
- nabumetone (Relafen)
- naproxen sodium (prescription-strength)
- naproxen (Naprosyn)
- piroxicam (Feldene)
- meloxicam (Mobic)
Disease-modifying antirheumatic drugs (DMARDs)
Unlike NSAIDs, which only treat the symptoms of RA, DMARDs work to suppress underlying inflammation in the body on a broad level. This helps both manage RA symptoms and slow the progression of the disease.
DMARDs are available by prescription only. Options include:
- methotrexate
- hydroxychloroquine
- sulfasalazine
- leflunomide
DMARDs may take several weeks or even months to take effect. In some cases, two or more DMARDs are prescribed to achieve the best possible outcomes.
Biologic drugs
Like DMARDs, biologics suppress the immune system to manage symptoms and slow or even halt the progression of RA. However, they work in a much more targeted way compared with DMARDs.
Biologics treatment options include:
- etanercept (Enbrel)
- infliximab (Remicade)
- adalimumab (Humira)
- anakinra (Kineret)
- abatacept (Orencia)
- rituximab (Rituxan)
- certolizumab pegol (Cimzia)
- golimumab (Simponi)
- tocilizumab (Actemra)
Biologics may be prescribed alone or in combination with another DMARD. While biologics have a set of potential side effects, they tend to be better tolerated and may take effect more rapidly than other drugs.
Janus kinase (JAK) inhibitors
JAK inhibitors are the newest treatment option for moderate to severe RA. They work in an even more targeted way than biologics to slow down the overactive inflammatory response in the body that’s seen in RA.
JAK inhibitor treatment options include:
- baracitinib (Olumiant)
- tofacitinib (Xeljanz)
- upadacitinib (Rinvoq)
Corticosteroids
Also known as steroids, corticosteroids are prescription drugs that work to reduce pain and inflammation. These drugs suppress the immune system to provide symptom relief quickly. However, they also come with a range of side effects, some potentially serious, including:
- increased blood sugar
- high blood pressure
- osteoporosis
- cataracts
- infection
- weight gain
As a result, most doctors only prescribe a short-term dose of corticosteroids for quick relief of an RA flare. In some cases, corticosteroids may also be used to provide relief while waiting for other drugs like DMARDs or biologics to start working.
Corticosteroid options include:
- prednisone (Deltasone, Sterapred, Liquid pred)
- dexamethasone (Dexpak, Taperpak, Decadron, Hexadrol)
- hydrocortisone (Cortef, A-Hydrocort, Hydrocortone, and others)
- methylprednisolone (Methacort, Depopred, Predacorten, and others)
What’s the standard first-line treatment for RA?
Traditional DMARDs like methotrexate have long been considered the gold standard in RA treatment. In fact, methotrexate is the most commonly prescribed drug for RA.
Despite more recent treatment advances, including biologics and JAK inhibitors, the
However, it’s important to work closely with your doctor to monitor how well your treatment is working and make adjustments as needed. This may mean optimizing your treatment dosage, adding an additional drug, or changing your treatment approach altogether.
A variety of treatments are available for RA, so it may take some trial and error to find the right medication or combination of drugs for you.
In addition to medications, following a healthy lifestyle can be beneficial for managing your RA, which may help slow disease progression.
Diet
There’s some evidence that eating an anti-inflammatory diet full of omega-3 fatty acids, antioxidants, and phytochemicals may help manage symptoms. For example, it may help to follow a Mediterranean-style diet that focuses on:
- fruits
- vegetables
- fish
- olive oil
- unrefined grains
- beans
- nuts and seeds
Meanwhile, experts recommend minimizing saturated fat, processed foods, refined foods, and red meat.
Exercise
While exercise may feel like the last thing you want to do when you have stiff, swollen joints, staying active may actually help improve RA symptoms and boost quality of life. Stick with low impact activities like walking, biking, water aerobics, and yoga to avoid added stress on your joints.
Other lifestyle tips
Incorporating additional healthy lifestyle factors into your RA management routine can also help. That includes:
- quitting smoking, if you smoke
- managing stress
- prioritizing quality of sleep
- reaching and maintaining a moderate weight
Talk with your doctor about how to incorporate healthy lifestyle habits into your RA management plan.
Without proper treatment, RA can lead to chronic pain and disability, and may even shorten your life expectancy. RA can also increase your risk of comorbidities
However, with the latest treatment options, combined with routine monitoring and following and a healthy lifestyle habits, someone diagnosed with RA today is likely to lead a very functional life.