Rheumatoid arthritis or RA, in short, is an autoimmune disease that involves the body’s immune system that normally protects the body by attacking foreign substances such as viruses and bacteria. Most commonly, rheumatoid arthritis affects the joints in the wrists, hands, elbows, ankles, feet, and knees. Most of the time, the effect on the joints is symmetrical, which means that when one hand or knee is affected, the other also feels similar symptoms. Furthermore, since RA can also affect body systems, such as the respiratory or cardiovascular systems, it is a systemic disease that can affect the entire body.

Common Treatment Options for Rheumatoid Arthritis

The goals of rheumatoid arthritis treatments are as follows:

• Put the disease into remission or stop the inflammation.
• Prevent damage to organs and joints.
• relieve symptoms
• Improve general well-being and physical function
• Reduce long-term complications

Doctors often adopt a combination of strategies to treat rheumatoid arthritis, including the following:

• Early Aggressive Treatment – The first strategy of RA treatment is to stop or reduce the inflammation as soon as possible, as they say, the sooner the better.
• Referral counseling – Physicians generally refer to inflammation during RA as disease activity. Therefore, the ultimate goal of this line of treatment is to stop progression and achieve remission. This eventually means that no signs or symptoms of active inflammation should be present. A strategy that is designed to achieve this goal is known as ‘treating the target’.
• Strict control – Bringing RA disease activity to a lower level and keeping it there is known as “tight RA control.” Studies show that tight control can slow down or even prevent joint damage. RA medications include several medications used to treat rheumatoid arthritis. Some of these are used primarily to relieve the symptoms of RA, while others are used to slow or stop the course of the disease and to inhibit structural damage.
• Medications to relieve symptoms – These are non-steroidal anti-inflammatory drugs known as NSAIDs and they are available over the counter or by prescription. These medications are typically used to relieve the inflammation and pain of arthritis. NSAIDs commonly include naproxen sodium, ketoprofen, and ibuprofen, among others. Doctors may prescribe celecoxib, which is a type of NSAID known as a COX-2 inhibitor, for people who have had or are at risk of stomach ulcers. These are considered safer for the stomach. Also, these medications can be taken orally or applied to the skin as a patch or cream, directly on the inflamed joint.
• Medications to slow disease activities include the following
  • corticosteroids – These medications include prednisolone, prednisone, and metiprednisolone, which are powerful, fast-acting anti-inflammatory drugs. These are used in RA to control potentially damaging inflammation while waiting for DMARDs and NSAIDs to take effect. Due to the risk of side effects from these medications, doctors generally prefer to use them only for the shortest possible time and also at low doses.
  • DMARD- This is an acronym for disease-modifying antirheumatic drugs. DMARDs are drugs that act by modifying the course of RA. Conventional DMARDs include azathioprine, cyclophosphamide, leflunomide, sulfasalazine, hydroxychloroquine, and methotrexate. These medications can be taken by mouth, self-injected, or given as an infusion in a clinic.
  • Biological – These are drugs that are a subset of DMARDs. However, biologics have been found to work faster than DMARDs and are injected or infused in a clinic. Because these medications target specific steps within the inflammatory process, they do not suppress the entire body’s immune response as other rheumatoid arthritis treatments do. Biologics can modify, slow, or stop the progression of RA in many people, even when other treatments have not been helpful.
  • JAK inhibitors – This is a new subcategory of DMARDs known as JAK inhibitors that block the JAK, Janus Kinase pathways that are involved in the body’s immune response. Tofacitinib is one such drug that falls into this category. Also, unlike biologics, JAK inhibitors can be administered orally.
  • Surgical – However, surgery may never be required for RA, but this may be an excellent option for patients who have sustained permanent damage that limits their mobility, daily activity, and independence. Joint replacement surgery can effectively restore function and relieve pain in joints that are severely damaged by RA. Surgical intervention involves replacing damaged parts of a joint with plastic and metal components. Knee and hip joint replacements are the most common, and sometimes even the elbows, wrists, shoulders, ankles, and other joints can also be considered for replacement surgery.

Newer Treatments for Rheumatoid Arthritis

There is a new drug called Remicade that is proving to be a breakthrough in the treatment of rheumatoid arthritis. This medication not only relieves pain, but can also prevent RA from progressing. Remicade can stop the inflammatory changes that characterize the potentially disabling RA condition and can permanently damage joints and cause chronic pain and disability. RA is a progressively debilitating condition that typically develops in people between the ages of 25 and 50. Remicade was developed by researchers when they discovered that a key trigger of inflammation was TNF, tumor necrosis factor, which is a chemical produced by the immune system. People who develop rheumatoid arthritis produce excessive levels of TNF, which, in turn, stimulate cells to cause inflammation in the joints. Remicade is specifically designed to chemically quench TNF and thereby neutralize its action. However, Remicade is not a cure for rheumatoid arthritis, but it is found that the joints recover from post-traumatic arthritis as the inflammation is turned off. Generally available as a subcutaneous injection similar to an insulin injection for patients with diabetes, Remicade can be self-injected at home twice a week, or it can also be given by intravenous drip just once every two months in a hospital.