Rheumatoid arthritis (RA) is a chronic, symmetrical inflammatory autoimmune disease that often begins in small joints and can progress to larger joints, affecting various body parts including the skin, eyes, heart, kidneys, and lungs. This condition can lead to the destruction of bone and cartilage in joints, and the weakening of tendons and ligaments. The treatment of rheumatoid arthritis focuses on controlling synovitis and preventing joint injury, with an emphasis on early and aggressive intervention. This approach is supported by observations that joint damage can start early in the disease’s course, and the longer active disease persists, the lower the likelihood of responding effectively to therapy.
The primary treatment of RA typically involves methotrexate (MTX) as initial disease-modifying antirheumatic drug (DMARD) monotherapy, regardless of the disease’s duration. This approach has been strongly recommended by the American College of Rheumatology (ACR) in their new 2020 guideline for rheumatoid arthritis treatments. The ACR guidelines emphasize methotrexate monotherapy as the first treatment for moderate to high disease activity. Additionally, the 2021 guidelines reaffirm methotrexate as the first-line treatment for RA, suggesting the avoidance of glucocorticoids (corticosteroids or steroids) as much as possible.
Treatment strategies for RA include medications, reduction of joint stress, physical and occupational therapy, and, in some cases, surgery. The types of drugs used in treatment include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, DMARDs, and biologic agents. These medications work by reducing inflammation, pain, and joint damage.
For more detailed information on the treatment of rheumatoid arthritis, you can visit the following resources:
UpToDate
Johns Hopkins Arthritis Center
Mayo Clinic
Arthritis Foundation
American Academy of Family Physicians
National Center for Biotechnology Information
AAFP Rheumatoid Arthritis Update
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