Non-Surgical Treatments for Rheumatoid Arthritis

Written by Lawrence G. Lenke, MD

Most patients with rheumatoid arthritis (RA) can be treated without surgery. A treatment plan is designed to control the disease, alleviate pain, maintain function (activities of daily living), and maximize quality of life.

For tips on lifstyle changes to help you manage rheumatoid arthritis, visit our Patients' Guide to Healthy Living with Rheumatoid Arthritis.
There is no cure for rheumatoid arthritis, although there are medications that can relieve symptoms and slow disease progression. The medication recommended by the doctor is based on your medical condition, age, other drugs you currently take, safety, cost, and your preference. In other words, not everyone with RA will be on the same medications and doses.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve inflammation and pain. NSAIDs should be taken with food to prevent stomach upset and stomach bleeding. To learn more about potential problems related to taking NSAIDs, click here.

Corticosteroid drugs reduce inflammation and can slow joint damage. Initially, you'll feel much better as the drug helps to reduce inflammation. However, over time the drug becomes less effective because your body adjusts to the anti-inflammatory effect. Side effects can include bone thinning, bruising, weight gain, and high blood pressure.

Disease-modifying anti-rheumatic drugs (DMARDs) act slowly to "modify" the disease. It can take several months before any benefit is noticed. These drugs may slow disease progression and save joint tissue from damage. A DMARD may be combined with an NSAID. The NSAID treats the symptoms while the DMARD works on modifying the disease.

Immunosuppressants may be recommended to conclude the autoimmune effects of rheumatoid arthritis.

Anti-TNF (Tumor Necrosis Factor) drugs, or TNF Inhibitors
Anti-TNF drugs block the action of TNF; a protein that promotes inflammation. TNF inhibitors include adalimumab (Humira) and etanercept (Enbrel).

Non-TNF biologics
These drugs, which work on different components of the immune system, are given injection or infusion. Abatacept (Orencia) is an example.

Janus Kinase Inhibitors (JAK)
This class of drug targets JAK pathways that are involved in the immune response in the human body. Tofacitinib citrate (Xeljanz) belongs to this drug class and may be prescribed in pill form to adults with RA.

Anti-depressant drugs can help some patients to cope with RA and its effects by relieving pain as well as improving mood.

Other Nonsurgical Treatments

Different types of physical therapy may be recommended for people with  rheumatoid arthritis to help restore strength, flexibility, improve mobility, coordination, and maintain function. Massage, hydrotherapy, and other modalities (passive therapies administered to the patient) may help reduce pain.

Adopt Healthier Lifestyle Habits

It's very important to maintain a healthy lifestyle. Eat a good diet, consider anti-inflammatory foods, and exercise regularly (as your body allows). Talk with your primary doctor and/or rheumatologist about alternative treatments for rheumatoid arthritis, such as acupuncture or relaxation therapy. Reducing your stress to reduce your rheumatoid arthritis pain is also an important, and many times undervalued, treatment option.

It is helpful to keep a medical diary noting medications that work, drug side effects, severity of symptoms, flare-ups, and remissions.

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