Rheumatoid arthritis (RA) is a chronic inflammatory condition affecting joints and also other organs including the skin, eyes, salivary glands, lungs, heart and blood vessels.  It is autoimmune disorder whereby your own immune system mistakenly attacks your own body cells.

The ‘Treat to Target’ approach involves initiating escalation of therapy until adequate control of the joint inflammation is achieved.  Taking medication is the only way to reduce the inflammatory process and get the disease under control.  Fortunately, there are a lot of medications for your doctor to choose from compared to 10 years ago.

Click to view John Hopkins Rheumatology video on Treatment of RA

Choice of Medications

A. Analgesics (to help control pain)

Paracetamol, co-dyramol or co-codamol

B. Non-Steroid Anti-Inflammatory Drugs (NSAID) (to help control pain and reduce inflammation)

Aspirin, Ibuprofen, Nurofen, Meloxicam

C. Steroids (to reduce inflammation)

Prednisolone, Hydroxycortisone

D. Disease Modifying Anti-Rheumatic Drugs (DMARD) (to reduce immune system attack)

Methotrexate, Sulphasalazine, Leflunomide (Arava), Hydroxychloroquine

E. Biologics (to reduce the immune system attack by targeting specific immune cells)

Influximab (Remicade), Etanercept (Enbrel), Adalimumab (Humira), Certolizumab (Cimzia), Golimumab (Simponi), Tocilizumab (Actemra), Sarilumab, Rituximab (Rituxan), Abatacept (Orencia)

F. JAK Inhibitors (to reduce immune system attack by targeting specific proteins inside cells)

Tofacitinib (Xeljanz), Baracitinib (Olumiant), Upadacitinab (Rinvoq)

Monitoring Your RA

Your doctor will use DMARDs as first line treatment for reduce the active inflammatory process so that your joints can be protected from permanent damage.  As these medications take time to start working, you may need a combination of medication to include Steroids or NSAID which start working faster. 

It is VERY IMPORTANT that you adhere to your doctor’s instructions because every patient will have different combinations of medication because of the varying degrees of disease presentation and tolerance to the side effects. 

As your disease may fluctuate from time to time, it is also NORMAL for your doctor to change the strength of the medication or change the combination of your medicine.

Although it can be depressing to feel that RA cannot are cured, be reassured that most disease can be controlled with medication.  Remember that once your joints are damaged, the damage is permanent and irreversible. 

Self Help and Monitoring

• Eat well and keep a healthy weight (biologics work better in people who are not overweight)
• Stop smoking if you are a smoker
• Keep your cholesterol under control (as patients with RA have a higher risk of strokes or heart disease)
• Do gentle exercises to improve the joint mobility
• Do regular blood tests to monitor your blood counts, liver and kidney function due to possible side effects from the medication
• See your doctor if your symptoms suddenly get worse because you may have a disease flare-up or medication side effects

Remember to keep your follow-up appointments and do your blood tests regularly to help keep your disease in remission

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If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.