There is no cure for rheumatoid arthritis but there are many medicines, therapies, procedures and lifestyle changes that can greatly improve your symptoms. The aims of treatment are to:
- reduce pain and stiffness in affected joints as much as possible,
- prevent joint damage, and
- minimise any disability caused by pain, joint damage or deformity
If you have had inflamed joints for more than six weeks and your GP suspects you have rheumatoid arthritis, you will be referred to a specialist rheumatologist (a doctor who deals specifically with arthritis). This is so the diagnosis can be confirmed and most appropriate treatment started as soon as possible.
Medication
Many different medicines are used to treat rheumatoid arthritis. Some aim to relieve symptoms and others help to slow the progression of the condition. Everyone experiences rheumatoid arthritis differently, so it may take time before your doctor finds the best combination of medication to suit your needs. Some of the different medicines that you may be prescribed are outlined below.
Analgesics:
Analgesics, more commonly known as painkillers, reduce pain rather than inflammation. The most commonly prescribed painkiller is paracetamol. Codeine is another analgesic, which is sometimes prescribed as a combined medicine with paracetamol (known as co-codamol).
Non-steroidal anti-inflammatory drugs (NSAIDs):
There are many different types of NSAIDs. Some of the most commonly used include ibuprofen and aspirin. Other types include diclofenac, fenoprofen and flurbiprofen. NSAIDs help to relieve pain and stiffness while also reducing inflammation. However, they will not slow down the progression of rheumatoid arthritis. When taken in high doses or over a long period of time, NSAIDs can cause complications, such as disgestive problems, stomach bleeding, kidney and liver damage, tinnitus (ringing in your ears) and high blood pressure.
Cox-2 selective inhibitors are a type of NSAID that are designed to be less harmful to the stomach. However, research has linked use of Cox-2 inhibitors to an increased risk of strokes, raised blood pressure, heart disease and heart attacks, so it is important to tell your GP if you have a history of high blood pressure or high cholesterol, or if you smoke.
Disease-modifying anti-rheumatic drugs (DMARDs): DMARDs are a type of medicine that help to ease symptoms and slow down the progression of rheumatoid arthritis. The earlier you start taking a DMARD, the more effective it will be. When antibodies attack the tissue in the joints, they produce chemicals that can cause further damage to the bones, tendons, ligaments and cartilage. DMARDS work by blocking the effects of these chemicals.
It can take four to six months before you start to notice a DMARD working. It's therefore important for you to keeping taking the medication, even if you do not notice it working at first. You may have to try two or three types of DMARD before finding the one that is most suitable for you. Once you and your doctor work out the most suitable DMARD, you will usually have to take the medicine indefinitely. Some of the most commonly prescribed DMARDs include sulfasalazine, methotrexate, gold injections and penicillamine.
Tumour necrosis factor (TNF) blockers are a more recent type of DMARD that help ease symptoms more quickly. The most commonly prescribed TNF blockers include infliximab, etanercept and adalimomab. TNF blockers can usually help to reduce swelling and pain in one to two weeks and can also slow down the progression of rheumatoid arthritis. However, TNF blockers are not suitable for everyone, as the known side effects include heart failure, infection and lymphoma (cancer of the lymphatic system - part of the body's defence system against infection). Your doctor will advise you about whether or not TNF blockers are suitable for you.
Corticosteroids:
Corticosteroids are a type of medicine that help to reduce pain, stiffness and swelling. They are usually used when NSAIDs fail to provide relief. They are commonly prescribed on a short term basis, often during a flare-up. If you have a single inflamed or swollen joint, your doctor may inject a steroid into the joint. Relief is rapid and the effect can last from a few weeks to several months, depending on the severity of your condition.
The long-term use of corticosteroids can have serious side effects. These can include weight gain, osteoporosis (thinning of the bones), easy bruising, muscle weakness and thinning of the skin. They can also make diabetes and glaucoma (an eye disease) worse.
Surgery
If your rheumatoid arthritis is particularly severe, you may need surgery. Arthroplasty is a type of surgery that reconstructs or replaces a diseased joint to help restore movement. However, not all joints can be replaced. The most commonly replaced joints are hips and knees. Osteotomy is another type of surgery that helps to realign joints. You may also need surgery on your hands, to repair damaged tendons (the tissue that connects muscle to bone).
Lifestyle
You should try and get plenty of rest during a flare-up, as this is when your joints can be particularly painful and inflamed. Putting further strain on very swollen and painful joints can often make pain and inflammation worse.
Exercise is very important for maintaining your general health and mobility. Try to keep as active as you can because the muscles around your joints will become weak if they are not used. A gentle form of exercise that does not put too much strain on your joints is best. Swimming, for example, helps exercise your muscles but puts very little strain on your joints because the water supports your weight.
A physiotherapist will be able to give you exercises to help improve your mobility. They will be able to devise an appropriate exercise plan for you. An occupational therapist can also advise you on ways you can adapt your lifestyle to give you more independence, confidence and control. Their advice can vary from practical solutions, such as helping you with everyday tasks, to teaching you relaxation techniques and coping skills.
Complementary therapies
Many people with rheumatoid arthritis try complementary therapies. In most cases, there have been no scientific studies and no evidence to prove that they are effective. However, there are some therapies, particularly those aimed at reducing the stress of living with rheumatoid arthritis, that may help to make you feel better in yourself. These include:
- Massage.
- Acupuncture - the insertion of fine needles at certain points on the skin.
- Osteopathy - a mixture of gentle and forceful massage techniques aimed to reduce pain and swelling.
- Chiropractic - involves careful manipulation of the joints, muscles and tendons to provide pain relief.
- Hydrotherapy - exercise in either a warm, shallow swimming pool or a special hydrotherapy bath.
- Electrotherapy - uses electrical impulses (tiny electrical shocks) to stimulate the nervous system.
- Nutritional supplements - such as glucosamine sulphate, chondroitin and fish oil.