Diagnosis
RA can be difficult to diagnose in its early stages because its early signs and symptoms are similar to many other diseases. It is difficult to confirm the diagnosis with a single blood test or physical exam.
During the physical exam, your doctor will check your joints for swelling, redness, and warmth. In addition, your doctor may check your reflexes and muscle strength.
Medications
Your doctor will decide which type of medication to recommend based on the severity of your symptoms and how long you have had RA.
▸NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, and others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems, and kidney damage.
▸Steroids. Corticosteroids, such as prednisone, reduce inflammation, relieve pain, and slow joint damage. Side effects may include bone thinning, weight gain, and diabetes. Doctors usually prescribe corticosteroids to relieve symptoms quickly and gradually taper the drug until it is stopped.
▸Conventional DMARDs. These drugs slow the progression of rheumatoid arthritis and protect joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, and others), leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine). Side effects of these drugs vary, but all can cause liver damage and serious lung infections.
▸Biologics. This newer class of DMARDs, also called biologic response modifiers, includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), becelimumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), salirumab (Kevzara), and tocilizumab (Actemra).
Generally, biologic DMARDs are most effective when used with a conventional DMARD, such as methotrexate. This class of drugs can also increase the risk of infection.
▸Targeted synthetic DMARDs. If conventional DMARDs and biologics don’t work, baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq) can be used. Higher doses of tofacitinib may increase the risk of blood clots in the lungs, serious heart-related events, and cancer.
Lifestyle and Home Remedies
If you have RA, you can take steps to self-care. When used along with your RA medications, these self-care measures can help you manage your signs and symptoms:
▸Exercise regularly. Gentle exercise helps strengthen the muscles around your joints and can also help relieve fatigue. Talk to your doctor before starting an exercise regimen. If you're just starting, start with a walk. Avoid exercising joints that are sore, injured, or severely inflamed.
▸Use heat or cold. Heat can help relieve pain by relaxing tight, painful muscles. Cold reduces the sensation of pain. Cold also has a numbing effect and can reduce swelling.
▸Relax. Find ways to relieve pain by reducing stress in your life. Techniques like guided mindfulness, deep breathing, and muscle relaxation can help manage pain.
Alternative Medicine
Some common complementary and alternative therapies that show promise for treating RA include:
▸Fish oil. Some preliminary studies show that cod liver oil supplements can reduce pain and stiffness associated with RA. Side effects include nausea, belching, and a fishy taste in the mouth. Cod liver oil can interfere with medications, so talk to your doctor before using it.
▸ Vegetable oils. The seeds of evening primrose, borage, and black currant contain a fatty acid that helps relieve pain and morning stiffness associated with rheumatoid arthritis. Side effects include headaches, diarrhea, and flatulence. Some vegetable oils can cause liver damage and interfere with medications, so talk to your doctor before using them.
▸ Tai chi. This exercise therapy involves gentle movements and stretching, combined with deep breathing. Many people practice tai chi to relieve stress in their lives. Small studies have found that tai chi can improve mood and quality of life in people with rheumatoid arthritis. Tai chi is safe to practice with a professional trainer. But don't do any movements that cause pain.
