Treating rheumatoid arthritis usually involves a combination of medications, movement therapy, and lifestyle measures to manage symptoms and slow disease progression.

Rheumatoid arthritis (RA) is an autoimmune disease that causes joint pain and inflammation. The condition is chronic, and there’s no cure. However, in recent years, new treatment options have provided a much better quality of life for people living with RA.

Treatment for the condition is comprehensive and focuses on:

  • slowing disease progression
  • avoiding joint damage
  • reducing daily pain
  • helping you stay active

Doctors typically recommend a combination of medications, physical therapy, and lifestyle changes to help manage RA. In some cases, they may recommend surgery or other treatments.

This article provides an overview of the common treatment options for RA and what to expect from each.

Doctors prescribe RA medications to slow disease progression and reduce inflammation and pain. The exact medications will depend on the severity of your condition, how you respond to medications, and your overall health.

DMARDs are medications that can help reduce symptoms while preventing joint damage and disability. They work by suppressing your immune system. This reduces inflammation and pain and helps prevent joint and tissue damage.

Traditional DMARDs

Traditional DMARDs suppress your entire immune system. Different DMARDs affect specific immune pathways, so you and your doctor might need to try a few options before finding the right one. It can also take a few months to feel the full effects of a DMARD.

Traditional DMARDs are usually available as pills that you take by mouth and include:

Side effects of DMARDs may include:

  • gastrointestinal (GI) problems, like nausea and diarrhea
  • rash or allergic reaction
  • more frequent infections

You might not be able to take DMARDs if you have certain other conditions, like severe liver disease or those that weaken your immune system. Doctors may also avoid prescribing DMARDs for people who are pregnant or nursing.

Biologics

Biologic treatments are a newer, more targeted class of DMARDs that can prevent your immune system from attacking your joints. You take them via injection or intravenous (IV) infusion. Doctors often prescribe them in combination with a traditional DMARD.

Biologics inhibit specific proteins or receptors that can cause inflammation. Some biologics specifically inhibit a protein called tumor necrosis factor-alpha (TNF-alpha), which can contribute to RA symptoms.

Common biologic treatments include:

TNF-alpha inhibitorsOther biologics
• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)
• certolizumab pegol (Cimzia)		• rituximab (Rituxan)
• abatacept (Orencia)
• tocilizumab (Actemra)
• sarilumab (Kevzara)

Biologics have many of the same side effects as traditional DMARDs, like GI problems and increased infections.

Biologics, particularly certolizumab, are typically safer during pregnancy than conventional DMARDs, according to 2023 guidelines.

Janus kinase (JAK) inhibitors

JAK inhibitors are a new type of DMARD that may help people who can’t take or don’t see improvements from other DMARDs. They affect immune signaling, which can ease joint pain and swelling. Research suggests JAK inhibitors are comparable to biologics in both effectiveness and safety.

Common JAK inhibitors include:

JAK inhibitors come in pill form for you to take by mouth.

Side effects of JAK inhibitors include infections, nausea, and dizziness.

Many people with RA also take medications to help manage pain. You might take these medications temporarily, during a flare-up, or daily, depending on your condition and the treatment plan you discuss with your doctor. Pain-relieving options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs reduce inflammation and relieve pain. Your doctor might recommend over-the-counter NSAIDs, such as ibuprofen or naproxen, or might prescribe stronger NSAIDs.
  • COX-2 inhibitors: COX-2 inhibitors, such as celecoxib (Celebrex), also reduce inflammation and pain. They’re intended to have fewer GI side effects and be safer for daily use than NSAIDs. However, newer research suggests they may increase your risk of cardiovascular side effects.
  • Steroids: Steroids can reduce inflammation and help relieve pain. You can take steroids as an injection or tablet. Steroids can have serious side effects and are only for short-term use.

Physical and occupational therapy will likely be part of your RA treatment plan. Therapy can help:

  • assess your current ability level
  • build your strength
  • reduce your pain
  • slow down joint damage
  • help you adapt your movements

Physical therapy

A physical therapist can also provide pain relief through massages and muscle stimulation. They can teach you exercises to do at home that will build your strength and reduce your pain.

You might have physical therapy when you first get an RA diagnosis or over the course of your condition when needed, such as if a specific joint begins causing you pain and difficulty.

Occupational therapy

An occupational therapist can help you maintain your ability to do everyday tasks on your own. They can also recommend supports and devices to assist you and teach you how to use them. These can include:

  • splints
  • braces
  • mobility aids
  • jar grips and door knob grips
  • railings for stairs and bathroom bars for support

People with severe or advanced RA may need surgery to fix damaged joints. The exact surgery you need will depend on which joint is damaged and the extent of the damage. Surgical options include:

  • Synovectomy: A synovectomy is a procedure to remove the inflamed lining of a joint.
  • Tendon repair: Surgery may help repair tendons around your joints that are torn or loose.
  • Carpal tunnel release: This procedure relieves pressure on the median nerve by cutting the carpal ligament. This can relieve wrist pain.
  • Arthroplasty: Also known as joint replacement, arthroplasty involves replacing the damaged joint with an artificial one.
  • Arthroscopy: Instead of replacing a joint, doctors may be able to repair the joint using a tool called an “arthroscope.”
  • Arthrodesis: Also known as joint fusion, arthrodesis involves removing the damaged joint and fusing together the neighboring bones. While it reduces pain, it also limits mobility.

Success rates for RA surgeries are variable and depend on several factors, such as which joints are affected. Your doctor can provide information on what procedure might be best for you.

Some people report that dietary changes help reduce their RA symptoms. This generally involves following an anti-inflammatory diet and avoiding foods high in sugar, artificial ingredients, and carbohydrates.

An anti-inflammatory diet includes foods such as:

  • fish
  • berries
  • avocados
  • peppers
  • dark leafy green vegetables
  • tomatoes
  • extra-virgin olive oil
  • dark chocolate

Other people with RA find that supplements can reduce inflammation. Studies show that omega-3 fish oil supplements may help reduce RA activity. Turmeric supplements may also help reduce RA inflammation, according to 2023 research.

Talk with your doctor before you begin any supplements to ensure they won’t negatively interact with your current prescriptions.

Making specific lifestyle changes on your own may help you reduce pain and manage RA. Recommended options include:

  • Increasing movement: It’s a great idea to keep moving even if you can’t fit a workout into your schedule. Research shows that physical activity improves health outcomes for people with RA. Changes like taking the stairs instead of the elevator can help you stay active and manage your RA.
  • Getting enough sleep: The Arthritis Foundation stresses the importance of sleep to restore energy and produce hormones that can repair torn muscle tissue. Research from 2023 suggests that disturbed sleep can contribute to depression, fatigue, and higher disease activity in people with RA.
  • Using hot and cold treatments: The heat of a warm bath or heating bed can soothe your joints and muscles, while the chill of an ice pack can numb the pain of swollen joints and reduce inflammation.

Some people find relief using complementary therapies. It’s important to use caution before trying complementary therapies, as research into their effectiveness and safety is lacking. Talk with your doctor before you begin any complementary therapy program.

Complementary therapies that may help relieve pain include:

It’s a good idea to look into the qualifications of complementary therapy providers before you see them. Acupuncturists, massage therapists, and chiropractors need to be licensed in many states. You can look up these professionals before your first visit to ensure they provide safe and appropriate care.

Resources for support

Social and emotional support can help you as you manage a chronic condition like RA. It helps to have a medical team you feel comfortable with. Support from friends and family can help you get through flare-ups and challenging days.

You may also benefit from connecting with other people living with RA. Support groups can give you a place to share struggles and triumphs. Consider the following resources:

There’s no cure for RA, but treatment can help reduce your pain, slow joint damage, and manage your condition. The right treatment options for you will depend on the severity of your RA and your overall health.

Treatment might include a combination of medications, physical and occupational therapy, surgery, and lifestyle measures. Some people also report pain relief from alternative treatments such as supplements or complementary therapies.

A support group can be a great place to discuss your treatment and get tips from others.