Treatments for Rheumatoid Arthritis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Alternative Therapies


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.

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.

The importance of early treatment for the prognosis of rheumatoid arthritis (RA). To improve the clinical outcome of RA, efforts should be directed towards diagnosing RA earlier and introducing disease-modifying antirheumatic drugs (DMARD) therapy immediately after the diagnosis has been made. PubMed, Swiss Med Wkly, 2013 Sep 19.

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.

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)

Non-pharmacological interventions for fatigue in rheumatoid arthritis. This review provides some evidence that physical activity and psychosocial interventions provide benefit in relation to self-reported fatigue in adults with rheumatoid arthritis. There is currently insufficient evidence of the effectiveness of other non-pharmacological interventions. PubMed, Cochrane Database Syst Rev, 2013 Aug 23.


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.


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.

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.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs(sDMARDs and bDMARDs): 2013 update. EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. PubMed, Ann Rheum Dis, 2013 Oct 25. (Also see DMARDs)

Current immunotherapy in Rheumatoid Arthritis. Antirheumatic drugs (DMARDs) are capable of controlling synovial inflammation and there are advantages and disadvantages of DMARD therapy with agents such as methotrexate, leflunomide, sulfasalazine, injectable gold and (hydroxy)chloroquine with biological therapies, and with the new era of kinase inhibitors. PubMed, Immunotherapy, 2013 Sep;5(9):955-74.

Ultrasound can improve the accuracy of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis to predict methotrexate requirement. Preliminary but vital information enables the methodology to confirm the presence of synovitis using ultrasound. PubMed, Arthritis Rheum, 2013 Apr;65(4):890-8.

Old drugs, old problems: where do we stand in prediction of rheumatoid arthritis responsiveness to methotrexate (MTX) and other synthetic disease modifying anti-rheumatic drugs (DMARDs)? BMC Medicine, 23 January 2013.


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)

Biologic agents for rheumatoid arthritis: Can we hypothesize new strategies of treatment? Research in this field is obviously not encouraged by pharmaceutical industries, but the efforts should be driven in this direction. PubMed, Med Hypotheses, 09/02/2013.


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)


Emerging cell and cytokine targets in rheumatoid arthritis. These exciting new approaches will considerably enhance our repertoire in the battle against this potentially devastating disease. PubMed, Nat Rev Rheumatol, 2013 Nov 12.


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)


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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