Rheumatoid arthritis: How to ease your symptoms

You finally have a diagnosis for those stiff, achy joints you've been experiencing: rheumatoid arthritis. Now it's time for treatment — and to keep those symptoms in check.

What are your options?

Early and aggressive treatment

The first goal in treating rheumatoid arthritis is usually to put the disease in remission by stopping or reducing inflammation. Early, aggressive treatment with medications improves the odds of remission, which can slow or even halt the pace of joint damage.

A number of drugs may be used to slow disease activity:

• Traditional disease-modifying antirheumatic drugs (DMARDs). These drugs are typically the first line of treatment.

  They commonly include methotrexate (Trexall, others), hydroxychloroquine (Plaquenil), leflunomide (Arava) and sulfasalazine (Azulfidine).

• Glucocorticoids. Because it can take weeks for DMARDs to start working, glucocorticoids (sometimes called corticosteroids) can bridge the gap and offer faster relief. These medications include prednisone and prednisolone.
• Biologics. These drugs work by targeting specific steps in the inflammatory process. They're used if traditional DMARDs aren't fully effective. They may be used alone or in combination with traditional DMARDs.
• Janus kinase (JAK) inhibitors. These drugs work by blocking the body's production of enzymes that play a role in joint inflammation. The only JAK inhibitor available in the U.S. for rheumatoid arthritis is tofacitinib (Xeljanz).

Easing symptoms

In addition to drugs that slow activity of the disease, other drugs may be used to relieve pain and other symptoms.

• Pain and inflammation relievers. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). They help with inflammation.

  The COX-2 inhibitor celecoxib (Celebrex) also can relieve pain but often with less stomach irritation than may accompany NSAIDs.

• Exercise. Regular physical activity is an important treatment for rheumatoid arthritis.

  Exercise helps you maintain flexibility and functionality in your joints. It also helps to stave off other conditions that often accompany rheumatoid arthritis, like heart disease and osteoporosis.

• Rest. Balance activity with periods of rest when your joints are painful or stiff. Rest can help reduce inflammation, as well as the fatigue that often accompanies a flare of symptoms.
• Consult with an expert. Ask an occupational therapist about steps to conserve your joints. A therapist may also recommend assistive devices to reduce strain on the joints.

Surgery

The best case scenario is that medications and lifestyle management will keep your joint damage to a minimum. But for people with permanent joint damage that limits daily functioning, surgery is an effective option to relieve pain and restore function.

Depending on the severity of damage, options range from surgery to remove the inflamed lining of the joint (synovectomy) to a total joint replacement.