Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily affecting the joints, with varying severity among patients. The treatment of RA is directed towards controlling synovitis and preventing joint injury. An early aggressive approach to treatment is recommended, as joint damage and potential disability can begin early in the disease course.
Methotrexate is typically the first-line drug for rheumatoid arthritis. Biologic agents, such as tumor necrosis factor inhibitors, are generally considered second-line agents or can be added for additional therapeutic effect. The goal of RA treatment now focuses on achieving the lowest possible level of disease activity and remission, if possible, while minimizing joint damage and enhancing physical function and quality of life. Methotrexate is considered the first-line DMARD (Disease-Modifying Antirheumatic Drug) agent for most patients with RA, known for its relatively rapid onset of action.
The American College of Rheumatology (ACR) published updated guidelines focused solely on the medical treatment of rheumatoid arthritis. These guidelines emphasize treating newly diagnosed patients with methotrexate first and managing using a “treat-to-target” approach to help patients reach treatment goals. The ACR updates its guideline for the treatment of RA every few years, with the latest changes appearing in 2020. Since then, new drugs have entered the market, older drugs have been reassessed, and more comprehensive strategies for treatment have been developed.
In some cases, rheumatoid arthritis surgery may be necessary. This can involve procedures such as synovectomy (removal of the inflamed joint lining) to reduce pain and improve joint flexibility, or tendon repair to address inflammation and joint damage that may cause tendons around the joint to loosen or rupture.
For more detailed information on the treatment of rheumatoid arthritis, you can refer to the following resources:
UpToDate
AAFP
Arthritis Foundation
Mayo Clinic
Johns Hopkins Arthritis Center
AAFP
NCBI
CreakyJoints
