Steroids — Steroids have powerful anti-inflammatory properties, commonly known as glucocorticoids or corticosteroids. Prednisone and prednisolone are examples of drugs in this class. Steroids can be administered orally, intravenously, or directly into a joint. Steroids alleviate RA symptoms such as pain and stiffness while reducing joint swelling and soreness.
Steroids are commonly used to treat RA, severely impair a person’s ability to operate normally. In this case, steroid medication may help reduce symptoms and preserve function until other slower-acting treatments with a better ability to prevent joint injury start working. Steroids may also be used to treat disease flare-ups while other treatments are being administered. In addition, low-dose steroids are occasionally administered for long-term usage in conjunction with DMARDs to manage disease activity.
Side effects – Steroids can cause weight gain, diabetes worsening, the development of cataracts in the eyes, bone loss (osteopenia and osteoporosis), and an increased risk of infection. As a result, when steroids are used to treat RA, the goal is to utilize the lowest feasible dose for the shortest amount of time.
Non-NSAID analgesics — Pain medications can alleviate discomfort, but they have little effect on inflammation. Two examples are Acetaminophen (brand name Tylenol) and capsaicin cream or ointment.
Opioids (narcotics) such as codeine, oxycodone, hydrocodone, and tramadol are generally discouraged because they have no anti-inflammatory effect. In addition, because of the long-term nature of RA, there is also a danger of dependence and addiction. On the other hand, treatment with a long-acting opioid may be explored for persons with late-stage RA and significant joint deterioration who are unable to undergo joint replacement surgery; however, this should be done only under the supervision of a rheumatologist or pain specialist.
Treatment of flares – Flares are periods when symptoms momentarily intensify; they can occur in addition to persistent inflammation. Your doctor may advise you to address flares by raising the doses of your current medications or adding new medications (such as injectable or oral steroids). Rest is also typically beneficial during flares.
What kind of treatment will I receive? — The type of meds recommended by your doctor will be determined by the severity of your RA and how well you respond to the treatments. For example, if you have early, mild arthritis, your treatment will most likely be different than if you have more severe arthritis or if your symptoms continue beyond initial therapies.
If treatment is ineffective, almost everyone with RA will be prescribed a DMARD as part of their treatment plan; a different DMARD, whether a conventional DMARDs or a biologic agent, will be substituted for or added to the initial medicine.
SURGERY
Even with treatment, some people will develop “end-stage” rheumatoid arthritis (RA), which means severe joint damage and loss of function even when there is no continuing inflammation. End-of-life RA therapy aims to alleviate pain, reduce or prevent further joint deterioration, maintain function, and relieve fatigue and weakness. Therefore, nonpharmacologic treatment is crucial, such as physical and occupational therapy.
Surgery may be suggested in some circumstances to improve pain and function in persons with end-stage RA. Surgery to stabilize or replace a damaged joint may be required.
PREGNANCY
Some drugs used to treat rheumatoid arthritis (RA) are not safe to use while pregnant. Separate information on RA in pregnancy is available.