Treatment Options

The range of rheumatoid arthritis treatments

• Analgesics
  Relieve pain
• NSAIDs
  and Steroids
  Relieve pain and reduce inflammation
• DMARDs
  Relieve pain and slow joint damage
• Biologics
  Targeted treatment to relieve pain and inflammation. Some can help prevent damage to the joints.

Analgesics - These drugs are used for pain relief and don't have any effect on inflammation. Analgesics may be better tolerated by those who are unable to take NSAIDs because of allergies or stomach problems. An example of over-the-counter analgesics is acetaminophen, which is available without a prescription. Prescription analgesics are also available.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - These drugs are used to reduce the pain and inflammation of arthritis. They do not contain steroids, which is why they are called "nonsteroidal". Examples of these medications include ibuprofen and ASA, and they are available either over-the-counter or with a prescription. It is important to remember that these medications work to improve symptoms but do not alter the course of the disease or prevent joint destruction.

Steroids - Cortisone is a hormone produced naturally by the body's adrenal glands that regulates routine inflammation from minor injuries. In the 1950s, doctors found that giving extra cortisone to patients with rheumatoid arthritis considerably improved their symptoms. From this discovery, corticosteroids, also known as steroids, were developed. Corticosteroids work quickly and are some of the oldest medications available for RA. Due to the potential adverse effects of long-term oral corticosteroids, these medications are often prescribed over a short period of time in inflammatory types of arthritis such as RA.

Disease-Modifying Antirheumatic Drugs (DMARDs) - DMARDs are a class of medications that suppress inflammation and may help to prevent damage to the joint. They have the potential to slow disease progression, possibly preserving joint function. DMARDs are available by prescription only and include medicines like methotrexate. Sometimes patients who do not respond adequately to one DMARD may be treated sequentially with another DMARD or with a combination of DMARDs.

Biologic Response Modifiers - These drugs help relieve pain, suppress inflammation, and prevent damage to the joints. Although biologics work in different ways, all block specific steps in the inflammation process. Some biologic therapies can also be used in combination with DMARDs. Talk with your healthcare professional about whether biologic therapy may be a treatment consideration.

Evidence is ample that joint damage occurs early in the disease and progresses relentlessly over the years. Therefore, the key goals of therapy in RA include early rapid control of joint inflammation and prevention of joint destruction.

The Canadian Rheumatology Association defines the goals of treatment as relief of the signs and symptoms of RA, such as joint swelling and tenderness; improvement of physical functioning and quality of life; and slowing the progression of joint damage.

You can help achieve these goals by becoming your own best advocate — by gaining knowledge on how to control the pain and possibly change the course of the disease. You can do this by making lifestyle changes such as losing weight, exercising, changing your diet, and limiting activities that can cause stress on your joints. You can also do this by seeking medical help and choosing and taking the medication that is right for you.

With rheumatoid arthritis (RA) affecting approximately 1% of the Canadian population, there are ongoing efforts by the medical community to understand the cause of this autoimmune disorder and develop additional treatments.

RA affects people differently, so treatment should be individualized to suit your specific needs. You may want to have a discussion with your healthcare professional about your symptoms, other illnesses you may have, and your lifestyle. This will help you both determine what kinds of therapy might work best for you. And because RA is a chronic disease that requires lifelong therapy and management, it's important to check in with your doctor regularly about your treatment.

Medications used specifically for RA focus on one or more of the following: relieving pain, reducing inflammation, limiting joint damage, and improving your overall function and well-being. It's possible that you have already been prescribed one or more of these drugs to control your symptoms related to RA. However, the more you know about the complete range of treatment options, the greater control you can have over your health. And keep in mind, there may be new treatments being introduced that you should be aware of and understand.

RA is a serious disease so it's important that you receive the proper treatment from someone who specializes in your condition. Learn why a rheumatologist may be the most medically qualified professional to treat your RA.

Why a rheumatologist?  

When you were first diagnosed with RA, you may have been treated with over-the-counter drugs, prescription pain relievers, NSAIDs or steroids — medicines that only treat the symptoms. If you're seeing a rheumatologist, however, you are possibly taking a disease-modifying antirheumatic drug, or DMARD, an RA medicine that modifies the disease. These medicines reduce symptoms and help slow the progressive joint damage of RA.

In addition to the development of DMARDs, another category of RA medication has been developed called biologic response modifiers, or biologics. Biologic medicines work on your immune system to help reduce the signs and symptoms of moderate to severe RA and have changed the way many rheumatologists treat RA.

Talk to your healthcare professional about selecting the most appropriate rheumatoid arthritis treatment for you.

Understanding how RA medications work and how long they may take to provide relief is part of determining which medication is right for you. Given that everyone reacts differently to medication, it's important to be patient and realistic in your expectations. Although you may not see results right away, the medication you're taking could, in fact, be working. If you have any concerns about how well your medication is working, speak with your doctor. He or she may make adjustments based on your body's response.

All medicines have side effects. Because of the range of side effects associated with over-the-counter medications, NSAIDs, steroids, DMARDs and biologics, these drugs should be used cautiously and under the supervision of a healthcare professional.

Make sure your doctor clearly communicates with you about the drug he or she has prescribed, why you will be taking it, what you can expect, and side effects to watch for.

Here's a list of things to keep in mind when you begin taking a new medication.

Medication tips

• Follow the directions on how and when to take your medicine
• Talk to your doctor about any other medical problems you may have
• Learn about your medication, its side effects, and how it interacts with other drugs
• Choose one pharmacy to fill your prescriptions. Establishing a relationship with one pharmacy can provide you with additional support in helping to answer any questions you may have in managing your rheumatoid arthritis.

The information provided in this guide is intended for educational purposes only and should not be used as a tool for self-medication. Please talk with your healthcare professional about your condition and treatment options.

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