- There’s no cure for rheumatoid arthritis (RA), but early treatment with medications, known as disease-modifying antirheumatic drugs (DMARDs), may be effective in pushing RA symptoms into remission.
- There are a variety of medications used to treat RA symptoms.
- A primary goal of most current RA treatments is to force the disease into remission.
Doctors have a growing number of ways to treat rheumatoid arthritis (RA) symptoms. In treating people with RA, doctors hope to stop inflammation and prevent joint and organ damage.
Another goal of RA treatment is to improve overall well-being. Aggressive care may result in remission.
There isn’t a cure for RA, but early treatment using disease-modifying antirheumatic drugs (DMARDs) may be effective in pushing RA symptoms into remission. DMARDs may also slow the progression of RA.
Common DMARDs include:
- methotrexate (Trexall and Otrexup)
- leflunomide (Arava)
- hydroxychloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
Slowing the progression of the condition can mean decreased damage to joints and other tissues affected by RA-related inflammation.
Biologics are a newer type of medication used to treat RA symptoms. These biological therapies, as they are also commonly called, tend to work faster than DMARDs. They suppress the immune response that causes inflammation.
If you try a conventional DMARD and don’t notice a decrease in swelling, pain, and stiffness after a few weeks, your doctor may suggest a biological therapy.
There are a number of biologics to choose from, including:
- abatacept (Orencia)
- rituximab (Rituxan)
- tocilizumab (Actemra)
Anti-TNF biologics, used to stop inflammation, include:
- adalimumab (Humira)
- certolizumab (Cimzia)
- etanercept (Enbrel)
Rather than searching for a “magic pill” to cure RA, some researchers are looking into how a combination of medications can help fight the disease.
Often, doctors will prescribe both a conventional DMARD (commonly methotrexate) along with a biologic if you’re not responding to a DMARD alone.
It’s important to remember that almost all medications come with side effects and associated risks. You’ll want to talk with your doctor about possible side effects before you begin your treatment.
More ways to treat RA
Over-the-counter (OTC) medications treat RA symptoms, but not the underlying disease.
These medications include nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil and Motrin IB) and naproxen sodium (Aleve).
Your doctor may prescribe you stronger NSAIDs, available by prescription only, to combat the inflammation and pain caused by RA.
Corticosteroid medications may also be used to reduce RA inflammation and reduce joint damage. Prednisone can be effective in relieving acute symptoms of RA, but long-term use carries risks.
Physical or occupational therapy can help keep your joints flexible. Assistive devices — like beaded seat covers in cars and book stands to give the hands a break — can reduce stress on joints when going about daily tasks or enjoying leisurely activities.
Surgery, which can reduce severe joint pain and improve everyday functions, is sometimes elected by people with RA.
Because RA is an autoimmune disease, most of the current research on treating RA focuses on the immune system.
Researchers are looking at ways to disrupt the faulty immune response that causes RA inflammation at both the cellular and microcellular level.
Scientists also have experimented with vaccines that target the immune system’s underlying response in RA.
The thinking is that DCs may also impede the ACPA (anti-citrullinated protein/peptide antibody), which is elevated in people with RA, response in humans.
While the therapy, dubbed Rheumavax, cleared a Phase 1 clinical trial in 2015, it’s still under development. Other vaccines targeting dendritic cells, which play a critical role in controlling the immune response, are being studied as well.
Fenebrutinib, a medication that impedes the action of the inflammatory enzyme Bruton’s tyrosine kinase (BTK) is currently being studied as a possible treatment for RA.
A 2019 study found that fenebrutinib, when given in combination with DMARDs (like methotrexate), was more effective than a placebo. This medication is also believed to be about as effective as adalimumab in relieving symptoms of RA.
Within the past decade, the U.S. Food and Drug Administration (FDA) has approved three new janus kinase (JAK) inhibitors:
- tofacitinib (Xeljanz)
- baricitinib (Olumiant)
- upadacitinib (Rinvoq)
These medications block chemical triggers of inflammation and can work in combination with methotrexate.
Taking a completely different tack, some researchers have experimented with stimulating the vagus nerve. This cranial nerve involved in the body’s inflammatory response is typically stimulated in addition to using methotrexate as a treatment method.
Preliminary findings from the 2019 study suggested that the combination of an implanted vague nerve stimulator and drug therapy could reduce RA symptoms better than methotrexate treatment alone.
Spontaneous remission is possible, particularly if your RA is in the early stages. This natural remission causes disease activity to disappear. With no signs of disease, medications are no longer needed.
Some patients who experience spontaneous remission may have what is known as undifferentiated arthritis (UA), a common inflammatory form of arthritis that includes joint swelling, pain, and stiffness — but it’s not classified as a specific rheumatologic disorder.
Many people with UA achieve spontaneous remission, though a number of other people do eventually develop RA.
Researchers suspect that treating UA with therapies normally used to treat RA could prevent more cases of the milder condition from developing into a chronic disorder.
In fact, the primary goal of most current RA treatments is to force the disease into remission.
Whereas RA treatment once focused on managing symptoms to prevent disability and long-term joint, bone, and soft tissue damage, a recent survey showed that achieving remission is the treatment goal of 88 percent of people with RA.
The availability and effectiveness of DMARDs has transformed the view of RA from being a chronic disabling disease to a condition commonly pushed into remission.
It’s possible that, the earlier you start treating your RA, the more likely it is that you’ll achieve remission.
There’s currently no cure for RA, and no way to know when or if there will be a cure in the future. At this time, treatments involving both medications and physiotherapy can help manage pain and prevent joint damage.
Researchers are exploring a variety of emerging therapies for RA — new medications, vaccines, and medical devices — to treat RA and push it into remission.