Rheumatoid Arthritis: Early Diagnosis, Treatment Aid in Best Outcomes

Rheumatoid arthritis (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.

Symptoms of RA include joint stiffness, especially in the morning. 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. Other RA symptoms include low-grade fevers, loss of energy, a diminished appetite, and rheumatoid nodules, which feel like firm lumps in the hands and elbows.

Correct Diagnosis Is Key

Many people who have RA initially believe they have osteoarthritis (OA), a degenerative condition that also causes joint pain and stiffness. But anyone with these symptoms should be evaluated by a doctor so an accurate diagnosis can be reached.

“Patients in whom a diagnosis of RA is suspected should be promptly referred to a rheumatologist so appropriate therapy can begin,” says Susan Goodman, MD, a rheumatologist at the Weill Cornell-affiliated Hospital for Special Surgery.

“If the diagnosis is RA, it is critically important to begin treatment. 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,” notes Dr. Goodman. “And ongoing follow-up care is equally important, to ensure that the treatment is achieving its goals and that disease activity is suppressed.”

Medication Options

Medications commonly used to treat RA are disease-modifying antirheumatic drugs (DMARDs). Traditional DMARDs include methotrexate, hydroxychloroquine (Plaquenil), leflunomide (Arava), and sulfasalazine (Azulfidine). These drugs block inflammation, prevent or decrease joint damage, and can actually alter the course of the disease.

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 a specific cytokine, tumor necrosis factor (TNF), include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certilizumab (Cimzia).

“Other biologics 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 a targeted therapy for RA that is given orally in pill form,” says Dr. Goodman.

Individualized Treatment

“There is great progress being made in developing a ‘precision medicine’ approach to the treatment of RA, recognizing that many patients do not respond well to therapy,” says Dr. Goodman. “These patients may benefit from therapeutic choices based on specific findings from analysis of their synovial tissue.” (The synovial tissue is located in the capsule that surrounds the joint.)

If you have RA, you need to see your rheumatologist at regular intervals so your response to treatment can be monitored. However, if your symptoms are under good control, “seeing” your doctor remotely may be a possibility.

“Patients should be evaluated and blood tests checked for evidence of drug toxicity every three months. When patients are experiencing no pain, swelling, or morning stiffness, telehealth is an option. However, when patients are not doing well, an in-person evaluation is essential,” explains Dr. Goodman.

Lifestyle Choices

It’s also important to include lifestyle strategies in the treatment of RA.

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 flares, so relaxation techniques such as deep breathing and meditation may help.

If you’re overweight or obese, make weight loss a priority, and if you smoke, quit; go to smokefree.gov for resources that will support your efforts.

“Both obesity and smoking are linked to increases in disease activity and joint damage,” says Dr. Goodman.

Adopting a healthy dietary pattern that includes whole, plant-based foods may help reduce inflammation that feeds RA flares. Dr. Goodman suggests a simple Mediterranean-style style diet. For dietary guidance, see What You Can Do.

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

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