Prevention and Treatment

Unfortunately, there is no cure for RA. The key to maintaining a quality of life while living with RA is determined by the management of treatment. In order to reduce inflammation, relieve pain and improve function, the following treatment suggestions include:

• Lifestyle modifications through proper and regular exercise

• Medications

• Surgery

Lifestyle

Cigarette smoking has the strongest evidence base as a modifiable lifestyle behavior that increases seropositive RA risk.⁶⁸ Excess weight, the effect of dietary habits, and physical activity may affect the severity of RA symptoms. Exercise and learning how and what techniques to use becomes a vital skill for those with RA. Personalized exercises can be designed by a physical therapist to assist in maintaining muscle strength and flexibility without overusing joints. Swimming is ideal, as this exercise avoids stress being placed on joints. Splints are recommended in order to immobilize and support joints while resting.⁶⁹ Cold or hot applications have assisted in palliative treatment measures used prior or after exercise therapy. Occupational therapists can provide helpful alternatives in reducing joint stress while performing daily activities with devices assisting in writing, lifting objects and eating. Foods that are high in antioxidants may help reduce inflammation, and resting is important. Psychiatric comorbidity with a chronic disease is linked with poor patient outcomes. Therefore, the current research assessed the correlation of rheumatoid arthritis (RA) with depression and anxiety disorders.⁷⁰ In one study, 41.7% of patients presented with depression: 25% moderate and 16.7% severe. The study showed a high prevalence of depression among patients with chronic inflammatory rheumatic diseases (CIRDs), especially those with high disease activity, chronic pain, and functional impairments. These results support the inflammatory hypothesis, emphasizing the role of systemic inflammation in the pathogenesis of depression.⁷¹

Medications

A broad range of medications have been FDA approved to treat RA. They vary in cost, effectiveness and side effects. According to the Cleveland Clinic, a well-respected institution, exercise, stretching, and anti-inflammatory diet, and maintaining proper posture and muscle movement and positioning are important tactics to undertake.⁷² Omega fish oils and turmeric are recommended in the correct doses, but fish oil can interfere with certain prescription medications. Take heed that glucosamine and MSM (methylsulfonylmethane) are not very helpful, and immune boosters of any type could be harmful.⁷² Some physicians recommend supplements, yet little evidence is available to qualify their effectiveness. Some research studies indicate omega-3 fatty acids, those in plant seed oils and certain fish, can potentially reduce inflammation, yet the recommended dose for positive effects appears too difficult to tolerate. If supplements or herbal remedies are considered, the physician should be consulted as many medications can interact negatively.⁷²

Medications fall into several categories, each requiring careful monitoring with periodic blood screening tests (Table 4). There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). Biologics are a subset of DMARDs. Analgesics and anti-inflammatory agents assist in relieving stiffness, pain and inflammation; however, they do not slow disease progression or prevent joint damage. Documented long-term effects from cortisone therapy have been determined undesirable; nevertheless, cortisone injections used adjunctively in treatment regimens have proven valuable.⁷³

Disease modifying anti-rheumatic drugs (DMARDs) are prescribed for altering the disease course while preventing joint and bone damage occurring from secondary inflammatory responses. They have been used separately or in combination with other medications with results reported as early as one month and up to six months from initial treatment. Early treatment with one effective DMARD, methotrexate, has shown favorable outcomes in RA years afterwards. Those prescribed with methotrexate continue with treatment regimens longer than other medications due to lessened side effects, effectiveness in controlling symptoms, and its ability to work in combination with biological agents. Immunosuppressant medications are used for those co-existing with systemic disease.^67,73

The latest category of medications are biological response modifiers (BRMs) known as biologics and are used to treat aggressive and debilitating cases when standard methods from one or more DMARDs have shown unfavorable responses. The BRMs target against cytokines triggering inflammation and approximately 70% of patients report improvement within the first two weeks from initial therapy. Their continued use is necessary in order to maintain results. When BRMs are combined with DMARDs, specifically methotrexate, greater efficacy has been indicated. BRMs exhibit few adverse reactions, unlike DMARDs yet side effects from long-term use remain unclear. BRMs are either injected or infused and mild skin irritations can occur at the injection site. Since BRMs suppress immune system functions, those individuals with active infections, including tuberculosis, or those prone to infection (e.g., diabetics) should be screened by their physician prior to treatment. Annual expenses for BRMs range from $17,000 to $25,000 with varying degrees of health insurance coverage.⁷³