Treatments for Rheumatoid Arthritis

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Alternative Therapies
Vagus Nerve Stimulation


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.

Intensive management for moderate rheumatoid arthritis: a qualitative study of patients' and practitioners' views. Some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients. PubMed, BMC Rheumatol, 2019 Mar 28;3:12.

Predictors of Treatment Response in Rheumatoid Arthritis. This review article discusses the approaches used to identify theranostic biomarkers and to present an overview of currently available biomarkers and of their performance. PubMed, Joint Bone Spine, 07/04/2018.

Long–term disease and patient–reported outcomes of a continuous treat–to–target (T2T) approach in patients with early rheumatoid arthritis in daily clinical practice. Continuous application of T2T in real–life RA patients leads to favourable disease–related and patient–related outcomes. PubMed, Clin Rheumatol, 02/01/2018.

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.

Pain in rheumatoid arthritis (RA): models and mechanisms. RA–related pain is frequently considered to be solely a consequence of inflammation in the joints; however, recent studies show that multiple mechanisms are involved. PubMed, Pain Manag, 2016;6(3):265-84. (Also see Pain Management)

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

The effect of cryotherapy on total antioxidative capacity in patients with active seropositive rheumatoid arthritis. The effect of cold treatments was examined on the antioxidative capacity of rheumatoid arthritis (RA) patients with active disease. PubMed, Rheumatol Int, 07/11/2017.

Vitamin D level in rheumatoid arthritis (RA) and its correlation with the disease activity: a meta–analysis. Our meta–analysis suggests that the vitamin D level is associated with susceptibility to RA and RA activity. PubMed, Clin Exp Rheumatol. 2016 Sep-Oct;34(5):827-833. (Also see Vitamin D Deficiency)

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), 2016 Jun;68(6):729-37.


Aerobic Exercise and Fatigue in Rheumatoid Arthritis (RA) Participants: A Meta–Analysis Using the Minimal Important Difference Approach. Land–based aerobic exercise is associated with statistically significant reductions in fatigue; however, it may be unlikely that a substantial number of participants with RA could obtain clinically relevant reductions in fatigue. PubMed, Arthritis Care Res (Hoboken), 2018 Dec;70(12):1735-1739.


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.

Tocilizumab and the Risk of Cardiovascular Disease (CVD): Direct Comparison Among Biologic Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis (RA) Patients. Tocilizumab was associated with a CVD risk comparable to that for etanercept as well as a number of other biologics used for the treatment of RA. PubMed, Arthritis Care Res (Hoboken), 2019 Aug;71(8):1004-1018. (Also see Clinical Trials)

Tapering biologic therapy for people with rheumatoid arthritis in remission: A review of patient perspectives and associated clinical evidence. More research is needed on tapering biologics, and should include studies of patient perspectives as well as health economic evaluations. PubMed, Musculoskeletal Care, 05/30/2019.

Association between autophagy and inflammation in patients with rheumatoid arthritis (RA) receiving biologic therapy. Elevated autophagy with significant correlation to inflammation suggests the involvement of autophagy in RA pathogenesis. PubMed, Arthritis Res Ther, 2018 Dec 5;20(1):268. (Also see Biologic Agents)

The effects of methotrexate (MTX) and hydroxychloroquine (HCQ) combination therapy vs methotrexate monotherapy in early rheumatoid arthritis (RA) patients. In contrast to indirect comparison review data, MTX–HCQ seems somewhat more effective after 6 months than MTX monotherapy in early RA patients. Rheumatology, 09/06/2018. (Also see DMARDs)

Predictors of disease activity and structural progression after treatment with adalimumab plus methotrexate or continued methotrexate monotherapy in patients with early rheumatoid arthritis. Findings suggested a relationship between the addition of adalimumab at 6 months after methotrexate failure and improved outcomes. PubMed, Ann Rheum Dis, 08/03/2018. (Also see Immunosuppressants)

Ability of disease–modifying antirheumatic drugs to prevent or delay rheumatoid arthritis (RA) onset: a systematic literature review and meta–analysis (MA). This MA demonstrates that early therapeutic intervention may significantly reduce the risk of RA onset in this very first phase of the disease. PubMed, Ann Rheum Dis, 06/08/2018. (Also see DMARDs)

Resveratrol (RSV) as an effective adjuvant therapy in the management of rheumatoid arthritis: a clinical study. It was found that the clinical markers and the disease activity score assessment for 28 joints were significantly lowered in the RSV–treated group. PubMed, Clin Rheumatol, 04/03/2018.

Safety and efficacy of alternate–day corticosteroid treatment (QOD CS) as adjunctive therapy for rheumatoid arthritis (RA) : a comparative study. QOD CS treatment leads to a lower infection rate and less CS dependence than does daily treatment and both RA treatments are equally effective. PubMed, Clin Rheumatol, 03/26/2018.

Residual disease activity (RDA) in rheumatoid arthritis (RA) patients treated with subcutaneous biologic drugs that achieved remission or low disease activity (LDA). RDA in RA was present even in patients with remission or LDA, especially for the patient's reported outcome and impaired function was also present in a significantly rate of patients. PubMed, Clin Rheumatol, 02/21/2018. (Also see Biologic Agents)

Dosing down and then discontinuing biologic therapy (bDMARD) in rheumatoid arthritis (RA): a review of the literature. In patients who have achieved low disease activity or remission, down–titration and discontinuation of bDMARD therapy may be attempted, with careful monitoring. PubMed, Int J Rheum Dis, 12/04/2017. (Also see DMARDs)

The combination of IL-6 and its soluble receptor is associated with the response of rheumatoid arthritis (RA) patients to tocilizumab. RA patients could be easily stratified prior to therapeutic intervention with two molecules related to the pathway blocked by tocilizumab. Seminars in Arthritis and Rheumatism, 11/03/2017. (Also see Interleukins)

Metabolic and cardiovascular benefits of hydroxychloroquine (HCQ) in patients with rheumatoid arthritis (RA) : a systematic review and meta–analysis. HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease–modifying antirheumatic drugs. PubMed, Ann Rheum Dis, 09/25/2017. (Also see DMARDs)

Response to Treatment with TNFa Inhibitors in Rheumatoid Arthritis Is Associated with High Levels of Granulocyte–macrophage colony–stimulating factor (GM-CSF) and GM-CSF+ T Lymphocytes. The use of biomarker signatures of distinct pro-inflammatory pathways could lead to evidence-based prescription of the most appropriate biological therapies for different RA patients. PubMed, Clin Rev Allergy Immunol, 05/09/2017. (Also see Biologic Agents)

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.

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, 2016 Apr;19(4):370-6.

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)

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.


Biologics or tofacitinib for people with rheumatoid arthritis (RA) unsuccessfully treated with biologics: a systematic review and network meta-analysis. Biologic or tofacitinib use was associated with clinically meaningful and statistically significant benefits compared to placebo or an active comparator among people with RA previously unsuccessfully treated with biologics. PubMed, Cochrane Database Syst Rev, 2017 Mar 10;3:CD012591. (Also see Biologic Agents)


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)


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.


Thymidylate synthase (TYMS) polymorphisms and responsiveness to or toxicity of methotrexate (MTX) in rheumatoid arthritis (RA). This meta–analysis demonstrates that the TYMS 2R/3R and 6 bp I/D polymorphisms may not be associated with non–responsiveness to or toxicity of MTX therapy in RA patients. PubMed, Z Rheumatol, 01/29/2018. (Also see Methotrexate)


Long–term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis (RA). Our original patient–reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long–lasting benefits in RA patients and pain relief was the most favorable effect. PubMed, Int J Rheum Dis, 09/05/2018.

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.

Vagus Nerve Stimulation

Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis (RA). Vagus nerve stimulation significantly inhibited tumor necrosis factor and IL-6 production and improved RA disease severity, even in some patients with therapy–resistant disease. PubMed, J Intern Med, 05/26/2017.

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