Fight Rheumatoid Arthritis with Medications and Lifestyle

If you’re female and over age 50, you’re about three times as likely as men in the same age group to develop rheumatoid arthritis (RA). RA is an autoimmune disorder—a condition in which the body’s immune system mistakenly attacks healthy cells or tissue as though it were fighting off an infection—that causes inflammation, pain, and stiffness of the joints.

“It is well known that RA is more common in women than in men, but the reasons for the gender difference are unclear. Sex hormones may be related to RA, since women frequently report a decrease in RA activity during pregnancy. In addition, women who breastfeed have a lower risk of developing RA,” says Susan Goodman, MD, a rheumatologist at the Weill Cornell-affiliated Hospital for Special Surgery.

RA Symptoms

The small joints in the hands and feet are the most commonly affected areas, but RA can cause pain, stiffness, and limited motion in any joint. RA can even affect organs, such as the lungs or eyes.

Other symptoms of RA include joint stiffness, especially in the morning, low-grade fevers, and loss of energy and appetite. Women with RA also may develop rheumatoid nodules, which feel like firm lumps in the hands and elbows.

Medications for RA

One of the most common types of medications used to treat RA are disease-modifying anti-rheumatic drugs (DMARDs). DMARDs block inflammation, alter the course of the disease, and prevent or decrease joint damage.

“Patients in whom a diagnosis of RA is suspected should be promptly referred to a rheumatologist so DMARD therapy can be initiated,” says Dr. Goodman. Traditional DMARDs include methotrexate (Rheumatrex, Trexall), hydroxychloroquine (Plaquenil), leflunomide (Arava), and sulfasalazine (Azulfidine).

Other drugs called “biologics” target specific chemicals called cytokines that drive inflammation and produce the symptoms of RA while damaging the joints. Biologics used for RA that target the cytokine TNF include adalimumab (Humira), etanercept (Enbril), infliximab (Remicade), golimumab (Simponi), and certilizumab (Cimzia.

“Biologics that have different targets include abatacept (Orencia), tocilizumab (Actemra), and rituximab (Rituxan).  These medications, which are given by injection, are typically used when a patient has severe RA that responds incompletely to the traditional DMARDs. Tofacitinib (Xeljanz) is the first targeted therapy that is given orally in pill form,” says Dr. Goodman. Medications can be combined when a single drug proves insufficient.

Disease Management

“While it is critically important to begin treatment promptly, it is just as important to ensure that the treatment is achieving its goals and that disease activity is suppressed,” notes Dr. Goodman. “Early treatment and following a ‘treat to target’ regimen most consistently leads to less joint damage, less pain, better function, and improved quality of life.”

If you have RA, you will need to see your rheumatologist at regular intervals so your response to treatment can be monitored, and adjustments can be made to your treatment plan if needed.

Other medications include non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and naproxen) and prednisone, a corticosteroid medication used to treat inflammatory conditions. However, Dr. Goodman notes that these medications alone will not achieve the goal of remission or prevent damage to the joints, so all patients with RA should be taking disease-modifying drugs.

Lifestyle Choices

Lifestyle strategies aid RA management and help prevent related health issues.

Sleep is one of your most powerful weapons against RA; the less quality sleep you get, the more active your RA. Stress has also been linked with RA symptom flares, so practicing relaxation techniques such as deep breathing, meditation, and visualization can help.

Following a healthy dietary pattern that includes plenty of whole, plant-based foods may reduce inflammation that feeds RA flare-ups. (For more information about healthy foods, see What You Can Do.) Limit your consumption of highly processed foods, such as sodas, snack foods, and sweets, which can have a pro-inflammatory effect.

Exercising can be difficult for RA patients, but low-impact activities, such as walking, warm-water aerobics, and yoga, can help reduce stiffness related to RA while protecting your joints.

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