Rheumatoid arthritis (RA) is an autoimmune disorder characterized by inflammation and pain in the joints. Unlike osteoarthritis— the most common type of arthritis—RA isn’t due to normal wear and tear but is caused by immune cells attacking the body. RA’s onset can be much earlier than osteoarthritis, although it can occur at any age.
Dealing with arthritis pain requires addressing the root cause, so each type of disease has different management techniques. We spoke with Dilrukshie Cooray, MD, FACR, a rheumatologist with the
Torrance Memorial Physician Network and an assistant clinical professor of medicine at the UCLA School of Medicine, about how to approach RA pain.
What are the most common ways to deal with rheumatoid arthritis pain?
The most important factor in treating RA is diagnosing the disease early and starting patients on therapy as soon as possible. Individuals with RA are at risk for severe joint deformities, so it is imperative to start therapy early not only to treat the symptoms, like inflammation and pain, but also to prevent the severe joint deformities associated with progression.
We often start with medicines known as disease-modifying antirheumatic drugs or DMARDs. DMARDs can be classified as traditional or biologic. Examples of traditional DMARDs include methotrexate, sulfasalazine, Plaquenil and Arava. Depending on the severity of their disease, patients may also be treated with biologic DMARDs. The goal of RA therapy is early remission, and several studies show that starting therapy early may induce remission.
Beyond prescription drugs, are there other lifestyle changes people can make to help with inflammation and pain?
Trying to maintain a healthy weight and lifestyle is very important. In individuals with arthritis of any type, weight-bearing exercises may cause discomfort. We typically recommend non-weight bearing exercises such as aquatic therapy and tai chi, which do not put stress on the joints.
Physical therapy (PT) can also be helpful in those individuals who have long-standing RA and chronic deformities as a result. The idea is to try to increase their range of motion and strengthen their muscles. We use PT as an adjunct to other therapies to manage many different types of arthritides, not just RA.
Also important are healthful living practices. Eating a healthy and balanced diet is essential. Additionally, it is imperative to manage high cholesterol and hypertension in patients with RA, as there is an increased risk for developing cardiovascular disease in these individuals.
What about drugs for pain management?
Typically, once patients with RA start on the appropriate medications, inflammation should subside and pain should improve. If pain symptoms continue even after inflammation has subsided, then other causes for the pain should be evaluated and addressed.
We usually want to avoid long-term narcotics to treat this disease and to utilize RA drugs as much as possible to bring the disease under control. Narcotics do not alter the course of the disease in any way and ultimately may be more harmful than helpful in patients with RA.
What happens if a patient doesn’t respond to medications?
Some patients may not respond to just one medicine initially. Most patients require treatment with more than one agent or require a combination of medicines. At this time, we have so many FDA-approved medicines to treat RA—if one doesn’t work, then it is reasonable to either add another agent or switch to another medicine.
It is important for patients to have a good collaboration with their rheumatologist to find the right class and agent that works. I tell my patients that if there is a day and time when it’s “convenient” to have RA, now is it. We have so many therapies available to treat patients with RA. The ultimate goal is to impact quality of life and to try to help individuals with RA live a normal life.