How to manage rheumatoid arthritis

Rheumatoid arthritis (RA) primarily affects the joints. Unlike osteoarthritis, which results from wear and tear, RA occurs when the immune system mistakenly attacks the joint lining, causing inflammation. This leads to joint damage, pain, and swelling. RA, which is an autoimmune disorder, can affect various joints, including the hands, wrists, knees and feet, and may even impact other body systems such as the heart, lungs and blood vessels.

How can rheumatoid arthritis be managed?

Managing rheumatoid arthritis focuses on controlling inflammation, reducing pain, slowing joint damage, and improving overall quality of life. Effective management typically involves a combination of lifestyle changes, medications, and sometimes surgical interventions.

Medications

Medications are essential for controlling RA symptoms and preventing further joint damage. Common types of medication include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Help relieve pain and reduce inflammation.
• Corticosteroids: Used for short-term inflammation control; examples include prednisone.
• Disease-modifying antirheumatic drugs (DMARDs): Slow the progression of RA and prevent joint damage. Methotrexate is commonly used in this category.
• Biologic agents: A newer class of DMARDs that target specific parts of the immune system. Examples include adalimumab and etanercept.
• Janus kinase (JAK) inhibitors: A type of oral medication that helps reduce inflammation by targeting specific pathways in the immune system.

A rheumatologist will often tailor a treatment plan using a combination of these medications based on individual needs and the severity of the condition.

Physical therapy and exercise

Physical therapy plays a key role in RA management. A physiotherapist can design a personalised exercise program that includes:

• Strengthening exercises: Help maintain muscle support around affected joints.
• Flexibility and range-of-motion exercises: Improve mobility and reduce stiffness.
• Low-impact activities: Activities such as swimming, walking, and cycling are gentle on the joints while keeping them active.

Regular physical activity helps maintain joint function and reduce fatigue, but it’s important to strike a balance to avoid overexertion.

Lifestyle modifications

Certain lifestyle changes can make a significant difference in managing RA:

• Healthy diet: Consuming a balanced diet rich in antioxidants, omega-3 fatty acids, and anti-inflammatory foods can help manage inflammation. Fruits, vegetables, whole grains and fishlike salmon or mackerel are beneficial.
• Weight management: Maintaining a healthy weight reduces stress on the joints, especially in weight-bearing areas such as the hips and knees.
• Stress management: Techniques such as mindfulness, yoga, and meditation can help manage pain and improve mental health.
• Smoking cessation: Smoking can exacerbate RA and reduce the effectiveness of treatment, so quitting is highly recommended.

Supportive treatments

• Hot and cold therapy: Applying heat packs can relax muscles and stimulate blood flow, while cold packs can help numb the pain and reduce inflammation.
• Assistive devices: Splints, braces or specially designed tools can provide joint support and make daily activities easier.
• Occupational therapy: An occupational therapist can suggest ways to modify daily tasks to reduce joint strain.

What surgical options are available?

When conservative treatments for rheumatoid arthritis are insufficient and joint damage is severe, surgery may be considered to restore function and relieve pain. Surgical options include:

• Synovectomy: Removal of the inflamed joint lining.
• Tendon repair: Tendons around the joint may be damaged due to inflammation and can be surgically repaired.
• Joint replacement: Replacing damaged joints with prosthetics, such as in knee or hip replacement surgeries.
• Joint fusion: Recommended when joint replacement is not feasible, fusion may help stabilise or realign the joint.

What is the outlook for people with rheumatoid arthritis?

With advances in medication and treatment approaches, many individuals with RA can achieve significant symptom relief and maintain a good quality of life. Early diagnosis and proactive management are crucial for preventing joint damage and ensuring long-term health. Regular follow-ups with a rheumatologist, adherence to treatment, and healthy lifestyle choices contribute to better outcomes and improved day-to-day functioning.