Rheumatoid Arthritis Treatment Options

NSAIDs are a very common type of anti-inflammatory medication. Some forms of NSAIDs are available over the counter, such as ibuprofen, while other forms of NSAIDs require a prescription. NSAIDs are often a first-line treatment (what someone tries first) to help treat pain and inflammation from rheumatoid arthritis.

NSAIDs work by helping the body to block the production of a hormone-like chemical called prostaglandin. The body naturally produces prostaglandins to help regulate many systems in the body, including responding to acute injuries or pain. Prostaglandins contribute to inflammation and redness at the site of injury. However, for a more chronic condition like arthritis, too much prostaglandin production can lead to chronic inflammation and pain around the affected joints. NSAIDs help by temporarily blocking the body’s ability to produce prostaglandins and help reduce the amount of inflammation and pain. It is always best to speak with your doctor or pharmacist about how and when to take NSAIDs. Taking NSAIDs at the first sign of a flare, before the body can produce excess prostaglandins, may be more effective than starting it in the middle of a flare.

While NSAIDs can ease the symptoms of rheumatoid arthritis, it is important to note they are a temporary option that help with symptoms but once stopped, symptoms may return.  NSAIDs do not control the underlying problem, which is an overactive immune system, which is why your rheumatologist will recommend a rheumatoid arthritis specific treatment.

DMARDs are a class of arthritis medications that are designed to suppress and modify the immune system’s inflammation response. They help put out the “fire” of excessive inflammation throughout the body. These medications are often taken long-term and can take weeks before their effects are felt. Since each DMARD can affect different people differently, sometimes a combination of medications (known as combination therapy) is needed to be most effective at relieving symptoms and controlling the disease.

Biologics and biosimilars are a form of DMARD created from living cells. Each biologic or biosimilar works to better target the immune system to stop inflammation and prevent or slow disease progression.  

Janus Kinase or JAK inhibitors are another type of DMARD, belonging to a family of drugs called tsDMARDs (targeted synthetic disease-modifying anti-rheumatic drugs). These drugs interfere with the activity of specific enzymes in the body (e.g., JAK1, JAK2, JAK3, TYK2) to reduce the body’s overactive immune response by interrupting how signals are sent throughout the cells.

Medication therapies typically include 1 to 3 disease-modifying anti-rheumatic drugs (DMARDs).

• Most common: methotrexate (pills or injections weekly) with folic acid supplements to help reduce potential side effects such as mouth sores or gastrointestinal upset.
• Sometimes: sulfasalazine, hydroxychloroquine, leflunomide, or others will also be prescribed in combination with methotrexate.

You can expect follow-up lab tests and frequent monitoring to assess the effectiveness and side effects of your treatment.

Your rheumatologist can refine DMARD treatment to better control rheumatoid arthritis for advanced treatments:

• Switch to a different DMARD
• Add DMARDs in combination

For short-term use or flare-ups, treatment may include:

• Steroid pills, or corticosteroid injections in affected joints or intra-muscularly
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Non-opioid painkillers (analgesics)

Your rheumatologist can add biologics or other targeted treatments:

• TNF inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab)
• JAK inhibitors (tofacitinib, baricitinib, upadacitinib)
• IL-6 inhibitors (tocilizumab, sarilumab)
• Selective T cell co-stimulation modulator (abatacept)
• Selective B cell depletion (rituximab)