How is Rheumatoid Arthritis treated?
Waking up with stiff, swollen hands that take a long time to loosen up, finding it harder to open jars or button a shirt, feeling tired in a way that sleep does not fix: living with rheumatoid arthritis can affect nearly every part of daily life. It is a long-term condition, and there is currently no cure. But treatment has advanced enormously in recent years, and today many people with rheumatoid arthritis keep their disease well controlled and continue to work, travel, and enjoy time with their families.
Rheumatoid arthritis is an autoimmune disease that most commonly affects the joints of the hands, feet, wrists, elbows, knees, and ankles. In an autoimmune disease, the immune system mistakenly attacks the body’s own healthy tissue. In rheumatoid arthritis, the target is the lining of the joints, which becomes inflamed, swollen, and painful. Over time, uncontrolled inflammation can damage the cartilage and bone, and may also affect other parts of the body.
Rheumatoid arthritis has no cure, but several treatments can help alleviate its painful symptoms. The aims of treatment are to relieve pain and stiffness, reduce inflammation, prevent or slow joint damage, and keep you moving and independent. Most people use a combination of approaches.
- Medications: Relieve pain, reduce inflammation, and, importantly, stop the immune system from causing joint and tissue damage.
- Therapy: Physical and occupational therapy to keep your joints flexible, and to find easier ways of doing daily tasks.
- Assistive devices: Tools that reduce the strain on painful joints and make everyday activities easier.
- Surgery: Repairs damaged joints that have not responded to medication, to restore function and reduce pain.
Why Early Treatment Matters
With rheumatoid arthritis, timing makes a real difference. Joint damage can begin early in the disease, and once cartilage and bone are damaged, the changes cannot be reversed. Starting disease-modifying treatment early, ideally within the first few months, gives you the best chance of controlling the inflammation, protecting your joints, and preventing disability. Modern treatment aims for remission, or at least a low level of disease activity, and your doctor will check your progress regularly against this goal and adjust your treatment if needed.
Medications
Medications are the cornerstone of treatment. They fall into two broad groups: those that relieve symptoms, and those that tackle the underlying disease.
Medicines That Relieve Pain and Reduce Inflammation
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Reduce pain and swelling, but do not stop joint damage. They should be used at the lowest effective dose, as they can affect the stomach, kidneys, and heart in some people.
- Corticosteroids: Powerful anti-inflammatory medicines that can quickly bring flares under control, taken as tablets or as injections into a joint. They are generally used for the shortest time possible, because long-term use can cause side effects such as weight gain, thinning of the bones, and raised blood sugar.
Medicines That Stop the Disease from Damaging Your Joints
- Disease-modifying antirheumatic drugs (DMARDs): Slow down the immune system’s attack on your joints, and are the foundation of rheumatoid arthritis treatment. Methotrexate is the most commonly used. They can take several weeks to a few months to show their full effect, so please be patient, and keep taking them even when you start to feel better.
- Biologics: A newer type of medicine that targets specific parts of the immune system to stop it from triggering the inflammation that causes joint and tissue damage. They are usually given by injection or infusion, and are often used when standard DMARDs have not worked well enough. Newer targeted medicines in tablet form may also be an option in some cases.
Because DMARDs and biologics work by calming the immune system, they can slightly raise the risk of infection, and some need regular blood tests to monitor your liver, kidneys, and blood counts. Before starting a biologic, you will usually be screened for infections such as tuberculosis and hepatitis B, both of which are present in Singapore and can be reactivated by these treatments. Please tell your doctor about any other medicines or supplements that you take, and do not stop or change any medicine unless your doctor advises you to.
Therapy
A physical or occupational therapist can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, they can show you how to pick up objects from the floor correctly, using larger and stronger joints and sharing the load.
Assistive devices can make it easier to avoid stressing your painful joints. For example, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Other helpful devices include jar openers, built-up handles on utensils and toothbrushes, button hooks, and long-handled grabbers. An occupational therapist can recommend the aids that best suit your needs. Our Rehab Centre supports patients with physiotherapy and rehabilitation.
Surgery
Surgery can help to repair damaged joints that do not respond to medications that prevent or slow joint damage. It may help restore your ability to use your joint, reduce pain, and improve function. Rheumatoid arthritis surgery may involve one or more of the following procedures.
- Synovectomy: The removal of the inflamed lining of the joint, or synovium. The surgical procedure can be performed after an arthroscopy is done, and involves removing the synovial tissue surrounding the joint that has become inflamed and swollen.
- Tendon repair: Tendons around your joint may loosen or rupture due to inflammation and joint damage. This treatment involves making one or more small incisions in the skin over the damaged tendon and stitching the ends of the tendon together. The surrounding tissue is also examined for injuries to the blood vessels or nerves.
- Joint fusion: Fusing a joint may be recommended to stabilise or realign a joint, and for pain relief when a joint replacement is not an option. This procedure fuses two bones together to become one solid bone, making your joint more stable and allowing weight-bearing on it. Joint fusion surgery is performed on the spine, wrists, ankles, fingers, and feet.
Managing Flares
Rheumatoid arthritis often comes in waves. Periods when symptoms are quiet may be interrupted by flares, when joints become more painful, swollen, and stiff, and you feel more tired than usual. Flares can happen even when you are on treatment, and common triggers include infections, stress, missed medication, and overdoing activity.
- Keep track: Make a note of when flares happen, and what was going on at the time. This can help you and your doctor to spot patterns.
- Rest the affected joints: Take a break from strenuous activity, and use supports or splints if recommended, but keep gently moving to prevent stiffness.
- Use heat and cold: Warmth, such as a warm shower or heat pack, can ease stiffness, while a cold pack can help to settle swelling and pain in an inflamed joint.
- Stay in touch with your care team: A flare may mean that your treatment needs adjusting, so let your team know rather than waiting. Do not stop your regular medication.
Living Well with Rheumatoid Arthritis
- Protect your joints: Use larger, stronger joints for heavy tasks, such as carrying a bag on your forearm rather than gripping with your fingers, spread the load over several joints, and avoid staying in one position for too long.
- Pace yourself: Balance activity with rest, break big tasks into smaller steps, and plan your day around the times when you feel best. Many people find that mornings are stiffest.
- Keep moving: Gentle, low-impact exercise such as walking, swimming, cycling, and tai chi keeps joints flexible and muscles strong, and can help with fatigue and mood.
- Manage fatigue and sleep: Tiredness is one of the most common and frustrating symptoms. Regular sleep, short rests during the day, and keeping active can help.
- Eat well and keep a healthy weight: A balanced diet supports your overall health, and excess weight adds stress to your joints. Our Dietetics and Nutrition service can offer personalised advice that suits your food preferences.
- Do not smoke: Smoking increases the risk of developing rheumatoid arthritis, can make treatment less effective, and raises the risk of heart and lung problems.
- Look after your bones and heart: Rheumatoid arthritis, and some of its treatments, can affect bone strength and raise the risk of heart disease, so regular check-ups and a heart-healthy lifestyle are important.
- Stay up to date with vaccinations: Because some treatments lower the body’s defences, vaccines such as the influenza and pneumococcal vaccines are important. Please ask your doctor which vaccines are suitable for you, and about timing.
- Be mindful of the weather: Some people feel that their joints are more painful on cold or damp days, or when moving between hot outdoor spaces and cold air-conditioned rooms. Layers, and warm clothing or a light wrap in air-conditioned spaces, may help to keep your joints comfortable.
- Plan ahead for pregnancy: Some rheumatoid arthritis medicines are not safe in pregnancy, while others are. If you are planning a family, speak to your doctor early so that your treatment can be planned and adjusted safely.
- Look after your mind: Living with a long-term condition can be tiring and discouraging. Talk to your family, friends, and care team about how you are feeling, and ask about support if you need it.
Staying on Track Long Term
Rheumatoid arthritis needs ongoing care, and the best results come from a close partnership with your care team. Regular reviews and blood tests allow your doctor to check how active your disease is, monitor for side effects, and adjust your treatment as needed. Keep taking your medicines as prescribed, even when you feel well, as stopping them often leads to a flare. With consistent treatment and healthy habits, most people can keep their symptoms well controlled and continue to lead full and active lives.
If you have any questions about rheumatoid arthritis treatment, please speak with your doctor or our care team, who will be glad to help. Speak to our Specialists today.
