Treatments Besides DMARDs for Rheumatoid Arthritis

Treatment for rheumatoid arthritis almost always begins with disease-modifying medicine, but it doesn't stop there. Treatment can include pain relief, surgery, and different forms of therapy.

Dealing with pain

Early and rapid administration of disease-modifying antirheumatic medicines (DMARDs), such as those that alter immune system function, can have beneficial long-term effects on the course of rheumatoid arthritis. But in a crisis of rheumatoid arthritis pain, acute management of the immediate problem will improve your comfort while the disease-modifying medicines are starting to work. Rest and nonsteroidal anti-inflammatory drugs (NSAIDs) may help increase comfort during a crisis. NSAIDs such as ibuprofen and naproxen are available over the counter and work to suppress the inflammatory response that causes joint pain and swelling. Your doctor may also sometimes recommend corticosteroids, either orally or by injection into the muscle or joint, to help treat a flare-up of rheumatoid arthritis.

Surgery

Surgical intervention has a big role in the treatment of rheumatoid arthritis. The most common role of surgery is to correct the deformities caused by joint destruction in rheumatoid arthritis. But joint replacement can also be done. Typical areas operated on for rheumatoid arthritis include:

• The neck, to stabilize the portion of the upper spine where it meets the base of the skull.
• Hands and wrists, to correct deformities and allow improved fine-motor functioning.
• Hips and knees, usually to replace a joint.
• Ankles and toes, where joint destruction and deformity may occur and diminish your ability to walk.

Seek the care of orthopedic or plastic surgeons or podiatrists who have a particular interest or experience in the surgical treatment of inflammatory arthritis, as outcome can be particularly dependent on the experience of the surgeon.

Physical and occupational therapy

Both physical and occupational therapy may help maintain function in rheumatoid arthritis. Occupational therapists may be especially helpful in teaching people with significant loss of mobility how to use orthotic devices to open jars, use utensils, and do other activities of daily living. Physical therapists can help you keep your strength and range of motion of the joints affected by rheumatoid arthritis and instruct you in an appropriate exercise program.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
Last Revised	June 5, 2012