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Treating or not treating

Damage caused by RA can occur even when the pain is not severe.

Once the damage occurs, it cannot be reversed and can lead to significant pain and disability.

Patient

RA can cause permanent joint damage quickly when it is not treated and controlled.

- The Arthritis Society of Canada

What happens over time without adequate treatment?

Over several months of active disease, cartilage can start to become destroyed. This exposes bone, which begins to erode. Fingers, wrists and other affected joints may become deformed.

Stage 1: Cartilage destruction
Stage 2: Bone erosion
Stage 3: Deformities of fingers and wrists

Treatment of RA

There is no cure for RA; however, with the guidance of your doctor and other healthcare professionals, you can manage your RA.

  • Heat and cold to reduce pain and stiffness
  • You can take action to protect your joints. Physiotherapy and/or occupational therapy can help.
  • Medications can help to reduce inflammation in your joints in order to relieve pain and help slow joint damage.
  • Surgery may be an option for severely damaged joints.

NON-PHARMACOLOGICAL TREATMENTS 

Heat (warm shower or warm pack) can help:

  • Relieve pain
  • Relieve muscle spasms and tightness
  • Increase range of motion

Use a protective barrier, such as a towel, between the warm pack and the skin.

To avoid making symptoms worse, heat should not be applied to an already inflamed joint.

Cold (cold pack or crushed ice, ice cubes, or a bag of frozen vegetables) can help:

  • Decrease swelling
  • Decrease pain
  • Reduce blood flow to an inflamed joint

Use a protective barrier, such as a towel, between the cold pack and the skin. 

You can use your joints in a way that reduces the stress placed on them. 

By protecting your joints, you may:

  • Experience less RA pain
  • Perform tasks more easily
  • Help prevent further damage

Examples of how you can protect your joints:

  • Pace yourself throughout the day – alternate heavy tasks with lighter tasks and take breaks.
  • Position your joints to minimize stress (e.g., when carrying heavy items, keep them at waist height).
  • Talk to your doctor or other healthcare professional about splints, braces, or shoe inserts to help support your joints.

Consider assistive devices such as a cane and jar openers.

PHARMACOLOGICAL TREATMENTS

NSAIDs are a type of medication used to treat the pain and inflammation of arthritis.

NSAIDs:

  • Can be taken on an as-needed basis and do not need to be taken regularly

Some patients may find it helpful to take their NSAID on a regular basis to control their symptoms.

NSAIDs are available over the counter and by prescription. Talk to your doctor about NSAID treatment.

SIDE EFFECTS ASSOCIATED WITH NSAIDs:
Risk of GI side effects and thrombotic events; people with heart disease, or a history of stroke, or serious chest pain should not take NSAIDs. 

DMARDs are a class of medications used to treat inflammatory types of arthritis including RA. Methotrexate is a DMARD commonly used to treat RA.

Inflammation in the joint causes it to be warm, swollen and sore.

DMARDs:

  • DMARDs slow down the persistent inflammation (pain, swelling, and stiffness) in the joint and can help prevent damage to the joint

SIDE EFFECTS ASSOCIATED WITH DMARDs:
Vary according to agent: rash, nausea, abdominal discomfort, leucopenia, retinal and liver toxicity have been reported.

Cortisone (a steroid naturally present in our bodies):

  • Is a hormone produced naturally by the body’s adrenal glands.
  • Regulates routine inflammation from minor injuries and major traumas, such as broken bones or surgery.

The adrenal gland cannot produce enough cortisone naturally to regulate RA.

Corticosteroids may be used to get inflammation under control. Steroids work quickly (usually within a few days) and some patients may even start to feel better within hours of taking the first dose. 

SIDE EFFECTS ASSOCIATED WITH CORTICOSTEROIDS:
Osteoporosis, hypertension, weight gain, fluid retention, hyperglycemia, cataracts, skin fragility, and possibly premature atherosclerosis 

Biologics are a type of medication used to treat inflammatory types of arthritis, such as RA.

Biologics:

  • Different types of biologics vary in the way they work in the body.
  • Like DMARDs, biologics are used to suppress inflammation and can help prevent damage to the joint.
  • Can take some time to work. 
  • Can be combined with DMARDs.

SIDE EFFECTS ASSOCIATED WITH BIOLOGICS:
Infusion or injection site reactions, and increased risk of serious infections, tuberculosis, and lymphoma

Used to reduce the signs and symptoms of RA.

SIDE EFFECTS ASSOCIATED WITH SMALL-MOLECULE INHIBITORS:
Liver injury, elevated cholesterol levels, and increased risk of infections

SURGERY

Surgery may be considered by your doctor if a joint becomes badly damaged and is no longer functioning.

Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.

RA surgery may involve one or more of the following procedures:

  • Total joint replacement: The surgeon removes the damaged parts of the joint and inserts a prosthesis made of metal and plastic.
  • Tendon repair: In RA, inflammation and joint damage can cause tendons around your joint to loosen or rupture. The surgeon may be able to repair the tendons around your joint.
  • Joint fusion: Used when joint replacement is not an option. Surgically fusing a joint may be recommended to stabilize a joint and to relieve pain.

SIDE EFFECTS ASSOCIATED WITH SURGERY:
Vary depending on the procedure.