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Ongoing treatment

Treatment for rheumatoid arthritis usually continues throughout your life. Your health professional will want to closely monitor your condition. A rheumatologist should evaluate you regularly. Depending on your symptoms and treatment, this could be done as often as every 2 to 3 months or as infrequently as every 6 to 12 months. Testing, such as blood tests, may be done more often.

During each follow-up visit, your health professional will assess how active your disease is. Markers of disease activity are:⁶

• The amount of joint pain.
• How long morning stiffness lasts.
• The number of actively inflamed joints.
• How well you are functioning.
• Results of tests (erythrocyte sedimentation rate [ESR] or C-reactive protein)

Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, etanercept, adalimumab, infliximab, and leflunomide, will probably be used early in the course of your disease and for a prolonged period after treatment begins. DMARDs have been shown to slow the disease and may prevent joint destruction.

Corticosteroids may be used to treat your rheumatoid arthritis. They may be used as:

• Initial therapy until a DMARD has a chance to work (bridge therapy).
• A means of controlling flares of rheumatoid arthritis. When a single joint is inflamed, a corticosteroid injection can be effective in relieving symptoms.
• Disease management when DMARDS do not fully control the disease.

Because of the side effects of corticosteroids, your health professional will use the lowest possible dose and will try to reduce and eventually discontinue use of oral corticosteroids. However, this is not always possible.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or analgesics (pain relievers, such as acetaminophen) also may be used to relieve symptoms. NSAIDs can relieve pain and reduce inflammation in less severe cases of rheumatoid arthritis.

Exercise, physical therapy, and lifestyle changes can help you decrease joint pain. Many people with rheumatoid arthritis benefit from self-management plans that balance rest and activity. Steps you can take at home to relieve your symptoms and help control your disease include:

• Becoming involved in the day-to-day management of your disease. For more information, see:

  Taking an active role in the management of your rheumatoid arthritis.Staying active, physically, mentally, and socially.

• Resting when you are tired.
• Protecting your joints from injury.
• Eating a balanced diet.
• Exercising regularly.
• Controlling your weight.

Treatment if the condition gets worse

In some cases of rheumatoid arthritis, the disease does not respond to treatment. Treatment-resistant rheumatoid arthritis may be treated with much higher doses of medications or with different combinations of medications. In severe cases, surgery may be considered when the joints are severely damaged or deformed and are causing extreme pain. Surgery may include total joint replacement or other techniques to improve joint function.

A device called the Prosorba column may be used for severe cases of rheumatoid arthritis that have not responded to other treatment. This device is not used commonly. The Prosorba column filters your blood, potentially removing proteins that might attack your joints. This treatment is given once a week for 12 weeks. More study is needed to understand the long-term effectiveness and side effects of this treatment.⁹

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