Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects many joints, mainly the small joints of the hands and feet. It is a lifelong condition without a cure.
RA occurs when the immune system malfunctions and attacks healthy tissues. Untreated or severe RA can cause inflammation that also affects the organs. When RA attacks the joints, its target is the synovium (the lining of the joints). Over time, chronic inflammation can lead to bone erosion and joint deformity.
There is no permanent cure for RA. However, healthcare providers have many options for treating RA symptoms and getting the disease into remission. Remission is a time in which a person experiences few or no signs of the disease.
Keep reading to learn about how RA is treated, the latest research, and how remission in RA occurs.
Rheumatoid Arthritis Medications
Although there is no cure for RA, treating the condition can help you achieve drug-induced remission (remission resulting from RA treatments). And researchers have found that treating RA with disease-modifying antirheumatic drugs (DMARDs) can reduce symptoms and increase the possibility of remission.
RA pain and inflammation are commonly managed with nonsteroidal anti-inflammatory drugs (NSAIDs). Additional ways to manage RA are with physical and occupational therapies, surgery, home remedies, lifestyle changes, and alternative therapies.
Disease-Modifying Antirheumatic Drugs
DMARDs work to suppress the body’s overactive immune system and reduce inflammation. This effect takes weeks or months to occur. DMARDs also slow down RA disease progression.
There are three types of DMARDs: conventional, biologics, and targeted synthetic.
These DMARDs are slow-acting, and it might take weeks before you see improvement. You should keep taking them if you don’t notice any effects at first. You also shouldn’t stop taking them because you feel better. Stopping treatment can lead to symptoms returning or severe side effects.
The most commonly prescribed conventional DMARDs for RA are Rheumatrex (methotrexate), Azulfidine (sulfasalazine), Plaquenil (hydroxychloroquine), and Arava (leflunomide). They are also used to treat other types of inflammatory arthritis, including psoriatic arthritis and ankylosing spondylitis.
Side effects of conventional DMARDs include rash, temporary hair loss, abnormal liver function tests, digestive troubles (diarrhea, nausea, abdominal pain, etc.), nerve damage, and high blood pressure.
Biologic drug therapies for RA were first introduced in the 1990s. They work by blocking specific cells in the immune system to stop them from triggering inflammation. Biologics tend to work much quicker than conventional DMARDs.
Biologics are often prescribed to people who have tried other treatments and have not properly responded. They are also given in combination with methotrexate.
There are four categories of biologics for treating RA: tumor necrosis factor (TNF) inhibitors, interleukin (IL) inhibitors, B-cell inhibitors, and T-cell inhibitors. They are either administered with a needle injected under the skin or by intravenous infusion (into a vein).
- TNF inhibitors: These block tumor necrosis factor, a chemical that drives the inflammatory process. These include Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Simponi (golimumab), and Cimzia (certolizumab pegol).
- IL inhibitors; These stop the production of inflammatory chemicals made by the body, including IL-1, IL-6, and IL-17. An example is Actemra (tocilizumab).
- B-cell inhibitors: These affect B cells, white blood cells that carry proteins that trigger an immune system response. An example is Rituxan (rituximab).
- T-cell inhibitors: These block communication between T cells, a type of white blood cell. An example is Orencia (abatacept).
Common side effects of biologic DMARDs include:
- Redness, swelling, itching, bruising, or pain in the injection site location
- Increased risk for common and serious infections, including yeast, pneumonia, listeria, and tuberculosis
- Decreased blood counts
- Increases in cholesterol and liver enzyme levels
- Increased risk for some types of cancer, especially lymphoma (cancer of the lymphatic system)
These are a new type of DMARD given as an oral molecule. The first drug class in this category is Janus kinase (JAK) inhibitors. JAK inhibitors work by blocking the signaling of certain enzymes, which are involved in inflammation.
The Food and Drug Administration (FDA) has approved three JAK inhibitors for the treatment of RA: Xeljanz (tofacitinib), Olumiant (baricitinib), and Rinvoq (upadacitinib).
Common side effects of JAK inhibitors are:
- Gastrointestinal troubles: Nausea, indigestion, diarrhea, etc.
- Upper respiratory infections
- Increased cholesterol levels
Rare, but possible side effects of JAK inhibitors include the risk for all types of infection, abnormal blood counts and liver function tests, an increased risk for kidney problems, and a bowel perforation.
The FDA has also issued warnings about the increased risk for severe heart-related events (heart attack, stroke, blood clots, etc.) when using these drugs.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are commonly used to manage RA pain, inflammation, and swelling. These drugs do not slow down the disease and you will need DMARDs to prevent further joint damage and other disease complications.
NSAIDs work by blocking the body’s cyclooxygenase (COX) enzymes. These enzymes are responsible for promoting inflammation.
These drugs are available both over the counter (OTC) and with a prescription written by your healthcare provider. OTC NSAIDs used to treat RA include Advil (ibuprofen), aspirin, and Aleve (naproxen).
Prescription NSAIDs used in RA pain management include:
Side effects of NSAIDs include:
- Gastrointestinal troubles (constipation, diarrhea, abdominal
- Stomach ulcers and bleeding
- Kidney problems
- Anemia (a low number of healthy red blood cells)
- Leg swelling
- Abnormal liver tests
- Easy bruising
- Increases in blood pressure
All NSAIDs, especially in higher doses, are linked to an increased risk for stroke and heart attack. You should let your healthcare provider know if you have risk factors for heart disease, such as high blood pressure, high cholesterol, and smoking.
Your healthcare provider might prescribe a short-term corticosteroid to reduce a disease flare-up (a period of high disease activity, pain, and other symptoms) or while you wait for other RA medicines to take effect. Corticosteroids are given sparingly because of side effects and are available in pill form and as injections or intravenous (IV) infusions.
These drugs work quickly to bring down inflammation. A low dose of an oral corticosteroid might offer noticeable relief in a day or two. Joint pain, stiffness, and swelling should start to go down. A large dose given in one injection can offer a much quicker effect.
The research on corticosteroids for treating RA shows they are effective drugs. However, these drugs should be used with care and caution because of their high toxicity profiles.
Possible side effects of corticosteroids are:
- Fragile skin or easy bruising
- Increased infection risk
- High blood pressure or high sugar
- Sleep problems
- Mood changes
- Increased appetite and weight gain
Long-term use of corticosteroids can increase your risk for diabetes, heart problems, obesity, and osteoporosis (progressive bone thinning).
Not everyone will experience side effects using corticosteroids, but side effects tend to occur with higher doses and extended use. Also, side effects are less likely with corticosteroid injections.
Other Rheumatoid Arthritis Treatments
Medications are not the only treatments for people with RA. Your healthcare provider may add other therapies as part of your treatment plan.
Physical and Occupational Therapy
Your healthcare provider might refer you to a physical therapist who can teach you exercises that keep joints and muscles strong and flexible. An occupational therapist can recommend ways to do daily tasks that are easier on your joints. They can also recommend assistive devices that can help you avoid additional stress on your joints.
When medications and other treatments fail to prevent joint damage, your healthcare provider may suggest surgery to repair the damage. Surgery can reduce pain, improve function, and restore the use of a joint.
Surgeries commonly used in rheumatoid arthritis treatment are:
- Synovectomy: This surgery removes the inflamed synovial joint lining to reduce pain and improve joint flexibility.
- Joint fusion: This procedure involves fusing a joint to stabilize or realign it for pain relief.
- Total joint replacement: During this surgery, the surgeon removes the damaged parts of the joints and replaces them with metal and plastic prostheses.
- Arthroscopy: This is a minimally invasive procedure in which the surgeon removes bone and cartilage fragments.
All surgeries come with the risk of bleeding, infection, and pain. You should discuss all benefits and risks of surgery with your healthcare provider.
Lifestyle and Home Remedies
There are self-care steps you can take to manage RA. Along with your medications, the following can help with pain and other symptoms of RA:
- Exercise: Gentle exercise can help strengthen joints and muscles and reduce daily fatigue. You should check with your healthcare provider before starting any exercise routine and avoid exercising when joints are tender or inflamed. Walking, stretching, water exercises, swimming, and tai chi are all safe exercises for people with RA.
- Diet: There is no specific or recommended diet to treat RA, but some foods can help lower inflammation in your body. To manage RA, foods to add to your diet include fruits and vegetables, whole grains, fatty fish, and healthy oils like olive oil.
- Apply heat or cold: Heat can help to ease pain and relax stiff joints and muscles. Cold can help to dull down pain and decrease swelling.
- Relax: Find ways to reduce stress in your life to control RA pain. Try deep breathing, guided imagery, and other relaxation techniques.
Other Treatment Options
Some complementary and alternative medicine (CAM) therapies might help manage RA symptoms. CAM therapies are the term for medical products and therapies that are not part of standard medicine. They can help manage disease effects or medication side effects.
CAM options for managing RA you can try are:
RA is an autoimmune disease, which means research treatments focus on managing the effects on the immune system. Researchers are consistently looking at ways to disrupt and control immune system responses that lead to inflammation at both microscopic and macroscopic levels.
Currently, there is no cure for RA, but healthcare providers and researchers are working hard to find ways to help people with RA manage symptoms, prevent disease progression, and improve their quality of life.
Over the past few decades, there have been unprecedented changes in how RA is managed and treated. New medications and therapies continue to evolve, and researchers frequently look for new and effective medicines and treatment strategies.
The newest treatments for RA are JAK inhibitors, which have only been around for about a decade. Researchers are currently studying Bruton’s tyrosine kinase (BTK) inhibitors that target another enzyme that causes inflammation.
They are also studying stem cell therapy as a treatment option for people with RA. They believe stem therapy might help reduce inflammation and increase healthy tissues in the body.
Can RA Go Away on Its Own?
Spontaneous remission, sometimes called drug-free remission, in RA is rare. Most people who experience RA remission experience it while being treated with DMARDs.
Some research suggests drug-free remission might occur in early RA in a small percentage of people with the condition. A 2020 RMD Open system literature review aimed to identify whether drug-free remission was a possible and sustainable goal. The report’s authors determined that drug-free remission was possible in around 10% to 20% of people with RA.
They further noted that the absence of specific autoantibodies (substances in the body linked to RA) and shared epitope alleles (gene sequences related to RA) increased the chance of drug-free remission. The report’s authors could not determine if drug-free remission lasted longer than a year.
Can RA Go Into Remission?
RA remission means your disease is no longer active. For some people, that means they no longer experience RA symptoms, and for others, it could mean symptom-free periods with an occasional, mild flare-up.
Remission should be a long-term goal for you and your healthcare provider, and it is possible to experience it. But because there is no specific definition of “remission,” it is hard to know exactly how many people with RA experience it.
For example, a 2017 review of RA remission studies published in Therapeutic Advances in Musculoskeletal Disease found that remission rates ranged from 5% to around 45% based on the criteria used to define remission.
That review also shares that people with RA who maintain remission for six or more months have achieved sustained remission. The authors note sustained remission is linked to improved outcomes in function, patient-reported outcomes, and survival.
Your healthcare provider will use measures to determine if you are in remission based on the American College of Rheumatology criteria. These include:
- Less than 15 minutes of stiffness in the morning
- Little or no joint pain, tenderness, or swelling
- Blood tests that show low levels of inflammation
Rheumatoid arthritis is a type of inflammatory arthritis that occurs when the immune system malfunctions and starts attacking healthy tissues. RA pain attacks the linings of the joints, but it can also progress to attack the skin and other body organs.
There is no cure for RA, but treatment can lead a person to experience remission. With RA remission, you would experience few or no disease symptoms. Achieving remission requires treating RA with aggressive treatments called DMARDs.
If you experience remission, your symptoms can return. Most people with RA will experience times of remission and periods of relapse. If you are in remission and your symptoms return, you should reach out to your healthcare provider so they can help you find ways to better manage RA symptoms and pain.
A Word From Verywell
Rheumatoid arthritis is a lifelong condition you will have to manage actively. Even so, you can still live a healthy and thriving life with and despite RA.
The outlook for people with RA continues to improve as researchers look for new and more effective medicines and treatment strategies that promote disease remission. Current treatments help relieve symptoms, prevent joint damage and disease progression, and increase the potential for remission.
That means you are allowed to feel hopeful about the future. Staying on top of your treatment can help you to stay positive, especially on days when RA seems to be winning.
You should also see a rheumatologist (arthritis specialist) regularly and practice a healthy lifestyle to prevent flare-ups. If you ever find you are struggling to cope, reach out to loved ones, join a support group, or seek out the help of a mental health professional.
Frequently Asked Questions
Is rheumatoid arthritis curable permanently?
No. Remission is rarely permanent, and most people who experience it will alternate between remission and relapse, with periods of flare-ups. While drug-free remission is possible for a lucky few, relapse is more likely to occur if you stop taking your RA medications.
That means you will need to treat RA for the rest of your life to prevent symptoms from returning and to reduce complications of the disease.
What is the safest drug for rheumatoid arthritis?
Methotrexate is considered one of the safest treatments for rheumatoid arthritis. However, like any other treatment, it can cause side effects, including gastrointestinal troubles, fatigue, headaches, and brain fog. Most side effects resolve once a person has gotten used to the medication.
Does rheumatoid arthritis shorten your life?
Not necessarily. Rheumatoid arthritis, on its own, is not a fatal condition. However, unmanaged RA can lead to complications that can shorten a person’s life. Severe or untreated RA is linked to certain, adverse health conditions, including heart disease, lung disease, and some cancers.
Most of this risk comes from an overactive inflammatory response that RA treatments can successfully manage.