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Treatments for Rheumatoid Arthritis

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Overview
Alternative Therapies
Exercise
Medications
Surgery

Overview

Photo of costumes and hatsTreatments for rheumatoid arthritis include medications such as immunosuppressants and biologics, alternative therapies, supplements, and exercise.

Many patients respond to a combination of medication and alternative therapies.

Pain management is very important in rheumatoid arthritis, in order to maintain productivity and quality of life. Aspects of pain management may include medications as well as lifestyle adjustments such as stress reduction, pacing, and meditation.

Cysteine-rich 61 (Cyr61) participates in the pathogenesis of rheumatoid arthritis (RA) via promoting MMP-3 expression by fibroblast-like synoviocytes. This study provides new evidence that Cyr61 participates in RA pathogenesis not only as a pro–inflammatory factor but also plays a key role in bone erosion via promoting MMP-3 expression. PubMed, Mod Rheumatol, 2016 Sep 1:1-10. (Also see Antibodies)

MicroRNA–125b: association with disease activity and the treatment response of patients with early rheumatoid arthritis (RA). The expression of miR–125b in peripheral blood mononuclear cells of treatment–naïve patients may present a novel biomarker for monitoring the treatment outcome during the early phase of RA. BioMed Central, Arthritis Res Ther, 2016 Jun 2;18(1):124.

The effect on treatment response of fibromyalgic (FRA) symptoms in early rheumatoid arthritis (RA) patients: results from the ESPOIR cohort. Patients with FRA and RA will have a similar response to treatment, but may miss the target of remission or low disease activity. PubMed, Rheumatology (Oxford), 07/17/2015. (Also see Rheumatoid Arthritis in Overlap)

Pain in rheumatoid arthritis: a critical review. The management of pain requires various approaches that include pharmacological analgesia and biological and non-biological treatments and although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease. PubMed, Reumatismo, 2014 Jun 6;66(1):18-27. (Also see Pain Management)

Rheuminations: New RA Antibody Coming Soon? Patients with rheumatoid arthritis (RA) who don't do well with the available biologic therapies may soon have another therapeutic option: monoclonal antibodies that target granulocyte-macrophage colony-stimulating factor (GM-CSF). MedPage Today, 02/20/2014.

Rheumatoid Arthritis Treatments. It is essential that the patient and the patient's family be educated about the nature and course of the disease. The major goals of treatment of the arthritis are to reduce pain and discomfort, prevent deformities and loss of joint function, and maintain a productive and active life. Johns Hopkins University.

Alternative Therapies

Can creatine supplementation improve body composition and objective physical function in rheumatoid arthritis patients? In patients with RA, creatine supplementation increased muscle mass, but not strength or objective physical function. PubMed, Arthritis Care Res (Hoboken), 09/28/2015.

Eicosapentaenoic acid (EPA) and docosapentaenoic acid monoglycerides are more potent than docosahexaenoic acid monoglyceride to resolve inflammation in a rheumatoid arthritis model. Altogether, the present data suggest that Omega-3monoglyceride (MAG)–EPA, without vitamin E, represents a new potential therapeutic strategy for resolving inflammation in arthritis. PubMed, Arthritis Res Ther. 2015 May 29;17:142. (Also see Supplement Guide for Systemic Scleroderma)

Vitamin D status in rheumatoid arthritis (RA) patients: relation to clinical manifestations, disease activity, quality of life (QoL) and fibromyalgia syndrome (FMS). Special attention is required regarding vitamin D levels in RA patients with FMS and decreased QoL. Vitamin D should be corrected and supplementation considered among the RA management armamentarium. PubMed, Int J Rheum Dis, 2014 Oct 7. (Also see Fibromyalgia and Vitamin D Deficiency)

Exercise

Rheumatoid Arthritis and Exercise. Arthritis exercises can safely provide pain relief and build muscle strength. Certain kinds of exercise are proven to be safe for people with rheumatoid arthritis. There are three types you can do: stretching, strengthening, and conditioning. WebMD.

The effect of aerobic exercise training on fatigue in rheumatoid arthritis: a meta-analysis. There is evidence with low risk of bias that an aerobic exercise program is effective in reducing fatigue among patients with RA. PubMed, Arthritis Care Res (Hoboken), 01/26/2015.

Medications

Like many rheumatic diseases, not all rheumatoid arthritis patients respond to the same medication; therefore, patients try several different medications in hopes that one will eventually relieve their symptoms and slow the progression of the disease.

Biosimilars: implications for rheumatoid arthritis therapy. Five TNF inhibitor biosimilars have now been approved, and many other biosimilars to treat rheumatoid arthritis and other inflammatory diseases are in development. PubMed, Curr Opin Rheumatol, 03/16/2017. (Also see Biologic Agents)

Oral to subcutaneous (SC) methotrexate (MTX) dose–conversion strategy in the treatment of rheumatoid arthritis. SC administration provided higher exposure of MTX than the same dose given orally. PubMed, Rheumatol Int, 12/23/2016.

The effect of etanercept on traditional metabolic risk factors for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA). Patients with RA are at an increased risk of CVD and treatment with etanercept did not adversely affect levels of metabolic risk factors for CVD in patients with RA. PubMed, Clin Rheumatol, 10/05/2016. (Also see Biologic Agents)

Factors Associated with Sustained Remission in Rheumatoid Arthritis in Patients Treated with Anti–Tumour Necrosis Factor (anti–TNF). Evidence identified in this review supports current recommendations for methotrexate co–prescription and highlights the negative impact of particular clinical and demographic features on the likelihood of achieving optimal response to anti–TNF treatment. PubMed, Arthritis Care Res (Hoboken), 08/26/2016.

Association of the 5–aminoimidazole–4–carboxamide ribonucleotide transformylase gene (ATIC) 347 C/G polymorphism with responsiveness to and toxicity of methotrexate (MTX) in rheumatoid arthritis (RA): a meta–analysis. The ATIC 347 C/G polymorphism may be associated with non–responsiveness to and or toxicity of MTX in Caucasian RA patients. PubMed, Rheumatol Int, 07/05/2016.

Inadequate response or intolerability to oral methotrexate (MTX): Is it optimal to switch to subcutaneous (SC) methotrexate prior to considering therapy with biologics? SC MTX can prove to be more efficacious in patients refractory to oral MTX therapy or in patients experiencing severe gastrointestinal adverse effects. PubMed, Rheumatol Int, 03/02/2016. (Also see Immunosuppressants)

Rituximab Safe for Up to 11 Years in Rheumatoid Arthritis (RA). Rituximab had a consistent safety profile through multiple courses used in treating (RA) during 11 years of observation and was not associated with excess infection rates, cardiac events, or malignancies. Medscape, 09/01/2015. (Also see Biologic Agents)

The effect of tofacitinib on pneumococcal and influenza vaccine responses in rheumatoid arthritis. Among existing tofacitinib users, temporary drug discontinuation had limited effect upon influenza or 23-valent pneumococcal polysaccharide vaccine responses. PubMed, Ann Rheum Dis, 03/20/2015.

Treatment of moderate rheumatoid arthritis with different strategies in a health resource-limited setting: a cost-effectiveness analysis in the era of biosimilars. This study explores the cost–effectiveness of reduced doses or discontinuation of etanercept biosimilar (Yisaipu) in patients with moderately active rheumatoid arthritis (RA). PubMed, Clin Exp Rheumatol, 12/01/2014. (Also see Biologic Agents.)

Blood Test Could Prevent Medication Trial and Error for Rheumatoid Arthritis Patients. A molecule in the blood shows promise as a marker to predict whether individual rheumatoid arthritis patients are likely to benefit from biologic medications or other drugs should be tried. PubMed, Mayo Clinic News Network, 11/17/2014.

Infliximab has no apparent effect in the inner ear hearing function of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Our study showed that there was no notable change or deterioration in the hearing function of the patients with AS and RA who were treated with infliximab. PubMed, Clin Rheumatol, 2014 Oct;33(10):1481-7. (Also see Ankylosing Spondylitis)

Good response to infliximab in rheumatoid arthritis following failure of interleukin-1 receptor antagonist (IL-1Ra). Switching from IL-1Ra to infliximab is effective in improving disease activity and maintaining joint function. PubMed, Int J Rheum Dis, 2014 May 5.

Patients with the most advanced rheumatoid arthritis (RA) remain with Th1 systemic defects after TNF inhibitors treatment despite clinical improvement. Although therapy induced clinical improvement in almost all patients, those with advanced RA remained with signs of inflammation. PubMed, Rheumatol Int, 2014 Feb;34(2):243-53.

Biologics

Joint damage progression in patients with rheumatoid arthritis in clinical remission. Do biologics perform better than synthetic antirheumatic drugs? This observational study confirms that the rate of structural damage progression in clinical remission is decreased taking biologics compared to synthetic DMARD. However, while the difference is statistically significant it is probably not relevant from a clinical perspective. PubMed, J Rheumatol, 2014 Aug;41(8):1576-82. (Also see Biologic Agents and Disease-modifying Antirheumatic Drugs)

Corticosteroids

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population-based cohort study. RF-positive but not RF-negative patients were at increased risk of cardiovascular events following exposure to glucocorticoids. Wiley, Arthritis and Rheumatism, Vol 56, Issue 3, Pages 820-830. (Also see Medications)

DMARDS

Disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis. DMARDS reduce pain, swelling and stiffness over a period of weeks or months by slowing down the disease and its effects on your joints. Arthritis Research UK.

Immunosuppressants

The role of the Th17 cytokines IL-17 and IL-22 in Rheumatoid Arthritis pathogenesis and developments in cytokine immunotherapy. This review clarifies the role of Th17 cells and its cytokines in the pathogenesis of RA, and provides an overview of the clinical trials using immunotherapy to target this particular T helper subset or the two main effector cytokines by which the Th17 cells exert their function, IL-17 and IL-22. PubMed, Cytokine, 2015 Jul;74(1):101-7. (Also see Cytokines)

Three decades of low-dose methotrexate in rheumatoid arthritis: Can we predict toxicity? A summary of current data on low-dose MTX-associated toxicity, its prevention and predictors, keeping in mind practical RA clinical care. PubMed, Immunol Res, 2014 Nov 13. (Also see Methotrexate)

Surgery

National trends and in–hospital outcomes in patients with rheumatoid arthritis (RA) undergoing elective atlantoaxial spinal fusion (AASF) surgery. In–hospital morbidity and mortality rates of AASF in RA patients were higher than those of other major orthopaedic surgeries in RA patients and respiratory management is particularly important after AASF. PubMed, Clin Exp Rheumatol, 07/26/2016.

Ranges of motion after reverse shoulder arthroplasty improve significantly the first year after surgery in patients with rheumatoid arthritis. After shoulder joint replacement, the range of shoulder motion showed substantial changes during the first year only and should be taken into account when scheduling control visits, planning rehabilitation, and predicting the use of community services after the surgery. PubMed, Eur J Orthop Surg Traumatol, 05/19/2016.

Implant that eases agony of arthritis by zapping a nerve. A tiny disc planted under the skin could offer a revolutionary rheumatoid arthritis treatment and reduce crippling joint pain. Mail Online, 12/22/2014.

Mayo Study Finds Shoulder Replacement Eases Pain, Improves Motion in Rheumatoid Arthritis Patients. Despite surgical challenges with some rheumatoid arthritis patients, the procedure improves range of motion and reduces pain in nearly all cases, especially for those with intact rotator cuffs. Mayo Clinic News Network, 01/13/2014.

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