Medications

There are a variety of medicines to treat the pain and inflammation of RA. In some cases, medicines may be used in combination.

• Disease-modifying anti-rheumatic drugs (DMARDS)—to slow the course of the disease; used early in the course of the disease to prevent long-term damage:
  • Methotrexate (such as, Rheumatrex)
  • Hydroxychloroquine (such as, Plaquenil)
  • Sulfasalazine (such as, Azulfidine)
  • Leflunomide (such as, Arava)
  • Cyclosporine (such as, Neoral)
  • Penicillamine (such as, Cuprimine)
  • Gold (such as, Ridaura)
  • Minocycline (such as, Minocin)
• Immunosuppressive drugs (only used when other DMARDS are ineffective):
  • Azathioprine (such as, Imuran)
  • Cyclophosphamide (such as, Cytoxan)—rarely used
  • Chlorambucil (such as, Leukeran)—rarely used
• Over-the-counter medicines:
  • Acetaminophen (such as, Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
• Biologic response modifiers—drugs that interfere with the autoimmune response; includes tumor necrosis factor (TNF)-inhibitors, such as:
  • Etanercept (such as, Enbrel)
  • Infliximab (such as, Remicade)
  • Adalimumab (such as, Humira)
  • Golimumab (such as, Simponi)
  • Certolizumab (such as, Cimzia)

Steroids

Low-dose corticosteroids (such as, prednisone) are often used first. They may be tapered when other drugs start working. Avoid long-term steroid use. Corticosteroid injections to inflamed joints may also be used.

Rest and Exercise

Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.

Joint Care

Splints applied to painful joints may reduce pain and swelling. Devices that help with daily activities can also reduce stress on joints. Devices include:

• Zipper extenders
• Long-handled shoehorns
• Specially designed kitchen tools

Stress Reduction

Stress reduction can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a support group are two strategies you can use to reduce stress. Cognitive behavioral therapy, a form of talk therapy, and meditation may also offer benefits in reducing your pain and improving your ability to cope with RA.

Surgery

Joint replacement and tendon reconstruction help relieve severe joint damage.

Lifestyle Measures

These may relieve stiffness and weakness and reduce inflammation:

• Maintain a balance between rest and exercise.
• Attempt mild strength training.
• Participate in aerobic exercise (such as, walking, swimming, dancing).
• Avoid heavy-impact exercise.
• If you smoke, quit.
• Control weight.
• Participate in a physical therapy program.