Rheumatoid Arthritis: Treatments

While an estimated 10 million people in the UK are affected by arthritis (i), 400,000 of them suffer from a particular form of the disease called rheumatoid arthritis (ii).

This makes rheumatoid arthritis the second most common form of arthritis in the UK. Most often developing in people aged between 40 and 60 years old, it is also more common in women than men (women are said to be three times more likely to develop rheumatoid arthritis than men) (iii).

Rheumatoid arthritis is a result of the immune system attacking one or more joints and is often referred to as an autoimmune disease. The main symptoms include pain, stiffness and swelling in the joints, most commonly those found in the hands, feet and wrists. Those affected usually experience periods when their symptoms become worse – called flare-ups – as well as fatigue and weight loss, and sometimes problems in other parts of their bodies, including the eyes or the skin.

Types of arthritis

Other types of arthritis include the following:

Osteoarthritis

This is the most common form of arthritis in the UK, with 8.75 million people having requested osteoarthritis treatment (i). This degenerative condition damages the cartilage – the smooth layer that covers the bone surfaces in the joints. Find out more by reading our guide to osteoarthritis treatments.

Ankylosing spondylitis

This form of arthritis is an inflammatory condition that most commonly affects the spine (though other parts of the body can be affected, including the eyes, joints and tendons). It’s also more common in men than women (read about ankylosing spondylitis and its causes and treatments).

Fibromyalgia

Causing pain in the muscles, tendons and ligaments, fibromyalgia is more common in women than men too (according to Versus Arthritis, up to one person in every 25 may be affected (iv)).

Lupus

Systemic lupus erythematosus (SLE) – or lupus, as it is more commonly known – causes many symptoms, including joint pain and swelling, fatigue and skin rashes. Many sufferers have flare-ups, and symptoms can range from mild to severe. It’s about nine times more common in women than men, as well as more common in certain ethnic groups (in people of African origin, for instance) (v).

Gout

Affecting an estimated 1.4 percent of UK adults (vi), gout symptoms include sudden, or acute, attacks that cause excruciating pain in a joint, most commonly the big toe. It develops when a build-up of uric acid in the blood causes crystals of sodium urate to form in and around a joint, causing pain and inflammation. This type of arthritis affects more men than women.

Psoriatic arthritis

As its name suggests, psoriatic arthritis is an inflammatory joint condition that can develop if you have the skin condition psoriasis.

Juvenile idiopathic arthritis

This is the most common form of arthritis in children, and there are several different types. The good news is many cases improve as affected children get older.

Cervical spondylosis

A form of osteoarthritis, this affects the joints, bones and tissues in the neck and back. It’s a very common condition and most adults have some degree of cervical spondylosis as they get older, with degeneration of the bones and discs in the neck often starting some time after the age of around 30 (vii).

Reactive arthritis

Usually the result of an infection, reactive arthritis can affect the joints, eyes and urethra, and is most common in men aged between 20 and 40. In general, however, it’s uncommon, but it’s thought to have a genetic link, since around three out of four people with reactive arthritis have a gene called HLA-B27 (this is found in about one in 14 people in the UK) (viii).

Polymyalgia rheumatica

Causing symptoms in the muscles around the shoulders, neck and hips, polymyalgia rheumatica develops in one in 1,200 people each year, with most cases affecting the over-50s (particularly the over-70s). It’s more common in women than men, and affects more people of a northern European origin (ix).

Joint damage in rheumatoid arthritis

In rheumatoid arthritis, damage to the joints is caused by the body’s own immune system – though experts still don’t know why this happens. Antibodies that normally fight off infections start attacking the tissues surrounding the joints, causing inflammation in a part of the joint called the synovium (the thin layer of cells that cover your joints). This can make the joint look red and swollen, as well as make it feel warm or hot.

Pain is caused by irritation to the nerve endings in the joint, as well as the joint capsule stretching to accommodate the swelling. Then when the inflammation goes down, the capsule remains stretched – this explains why your joint may feel unstable, as the stretched capsule can no longer hold the joint in place effectively.

Each time this happens (that is, with each flare-up), your joint becomes more damaged, and in time it can become badly worn. If left untreated, repeated flare-ups could destroy the joint completely.

Lifestyle risks

While experts don’t know why the immune system behaves the way it does in people with rheumatoid arthritis, they believe there are some lifestyle factors that can affect the risk of developing it.

If you smoke, eat a lot of red meat and drink a lot of coffee, your risk of developing rheumatoid arthritis is higher than average. Meanwhile, Arthritis Research UK claims those who have a high vitamin C intake and who drink alcohol in moderation are less likely to develop rheumatoid arthritis (ii).

There may also be a genetic element to the disease since those with a family history of rheumatoid arthritis are thought to have a higher risk of developing it than average.

Hormones are also thought to be implicated, since rheumatoid arthritis is more common in women than men (though the hormone link is yet to be proven).

How is rheumatoid arthritis treated?

If you suspect you’re affected by any of the symptoms of rheumatoid arthritis, it’s important to see your GP for a diagnosis, since the earlier you start treatment the better the chance of reducing the risk of damage to your joints and the impact the condition may have on your day-to-day life.

Some treatments for rheumatoid arthritis are designed to stop the condition becoming worse. These include:

DMARDs

Disease-modifying anti-rheumatic drugs are usually the first treatment offered to people newly diagnosed with rheumatoid arthritis. These medicines – which include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide – aim to slow down the progression of the disease as well as relieve the symptoms. They work by blocking the effect of the chemicals your immune system releases when it attacks your joints.

Biological treatments

Sometimes used alongside DMARDs, these include medicines including adalimumab, etanercept, golimumab, infliximab, abatacept and rituximab. They come in the form of injections or intravenous drips that prevent certain chemicals in your blood triggering your immune system to attack your joints.

As well as medicines used to control the progression of rheumatoid arthritis, you may also be offered other treatments, including the following:

Pain relief

Your GP may recommend medication if you have rheumatoid arthritis to relieve pain and reduce inflammation. The type of painkiller you may receive will depend on how severe your pain is, and whether or not you have other medical conditions or health problems.

Pain relief medication may include paracetamol, a combination of paracetamol and codeine, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac, or prescription drugs called COX-2 inhibitors (also part of the NSAID family), such as celecoxib and etericoxib. People taking NSAIDs for rheumatoid arthritis may also be prescribed another medicine – such as a proton pump inhibitor – to reduce stomach acid, which can make the stomach problems common with NSAID use less likely.

Corticosteroids

Medicines that reduce swelling, stiffness and pain, these may be given as tablets or injections. The aim of corticosteroids in rheumatoid arthritis treatment is to provide short-term pain relief, such as during a flare-up.

Physical therapies

Depending on your symptoms and the problems they cause, you may also be referred to a physical therapist, such as a physiotherapist or occupational therapist. A physiotherapist, for instance, may recommend hydrotherapy to help relieve your symptoms, while an occupational therapist may give you advice to help with problems your condition may be causing at work or around the home.

Surgery

In severe cases, joint replacement operations may be recommended. Other, more minor, surgical procedures are also used, such as that to release a nerve or tendon.

Rheumatoid arthritis: how to help yourself

While medical treatments can help control the symptoms of rheumatoid arthritis and reduce the amount of damage to your joints, there are also some things you can do yourself that may be useful:

Eat healthily

According to Versus Arthritis, there’s no single diet that will help everyone with rheumatoid arthritis, but some people find their symptoms improve when they change what they eat (x). The charity does, however, have some dietary advice for people with any type of arthritis:

• Try to eat a balanced and varied diet to get all the vitamins, minerals and other nutrients your body needs.

• Choose foods that are part of the Mediterranean-style diet, such as fish, pulses, nuts, olive oil and plenty of fruit and vegetables.

• Get a good supply of omega-3 fatty acids – from fish, for example.

Eating healthily can also help support your general wellbeing and keep your weight in check (excess weight puts more pressure on your joints).

Take regular exercise

Regular exercise can help you to manage your weight, plus it keeps your joints mobile and the supporting muscles strong. But if you have rheumatoid arthritis, it’s important to rest your joints too, particularly when you have a flare-up.

Try to notice which activities trigger flare-ups and which don’t cause any problems – according to the NHS, high-impact exercises such as running or contact sports such as rugby and football tend to be more likely to bring on your symptoms, while activities such as swimming, cycling, walking and aqua aerobics are usually fine to carry on with (xi).

Learn to relax

Any condition that causes chronic pain can be very stressful. And rheumatoid arthritis is no exception. But if you can learn to relax more, you may be able to manage your stress levels more effectively. Breathing deeply can help: inhale for a slow count of four and exhale for a count of six until you feel calmer. Also try to get plenty of sleep – take painkillers or have a warm bath before going to bed for less pain and stiffness in your joints.

Practise mindfulness

Exercises that help you to focus on the present moment and become more positive – known as mindfulness – may help with inflammatory forms of arthritis, suggest researchers writing in the Annals of Rheumatic Diseases (xii). Find out more about mindfulness by visiting bemindful.co.uk, a Mental Health Foundation website.

Natural arthritis remedies

Conventional therapy for rheumatoid arthritis is based on medication. But there are gentler remedies that may also help to provide relief when used alongside conventional treatments:
 

Fish oils

As they are a good source of omega-3 essential fatty acids, fish oils are thought to help fight inflammation in the joints by affecting the body’s production of pro-inflammatory substances called prostaglandins. Omega-3s may also have a protective effect on joints. According to one study, women who ate the equivalent of one serving of oily fish a week had a 52 percent lower risk of developing rheumatoid arthritis compared to those who ate less (xiii). Another study, where participants with rheumatoid arthritis were taking DMARDs, suggests daily supplementation with omega-3 has significant clinical benefits, and that it may also reduce the need for painkillers (xiv).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish oils.

Rosehip

There is also evidence to suggest that rosehip may be effective in relieving some of the symptoms associated with rheumatoid arthritis (xv). Versus Arthritis experts also point out that there is evidence to suggest rosehip may be effective in relieving some rheumatoid arthritis symptoms (xvi). This herb may work because it contains the antioxidant vitamin C as well as polyphenols and anthocyanins, plant compounds that are thought to help relieve joint inflammation and protect joints against damage.
 

Devil’s claw

This herbal product is used for the relief of rheumatic pain as well as general aches and pains in the joints (based on traditional use only). Indeed, evidence suggests taking devil’s claw may help reduce the pain of rheumatoid arthritis (xvii).
 

Glucosamine

Often sourced from shrimp or crab shell, glucosamine is frequently used as a supplement for osteoarthritis. But some natural health practitioners recommend it for rheumatoid arthritis too. One study suggests a daily 1,500mg dose of glucosamine may improve rheumatoid arthritis symptoms, despite the fact that blood tests failed to confirm a reduction in inflammation (xviii).
 

Pine bark extract

This herbal extract, marketed under the trade name Pycnogenol, is an excellent source of plant compounds called flavonoids – including procyandins and anthocyanidins – that are widely believed to have antioxidant and anti-inflammatory effects. There is also some evidence it may help regulate the immune system to prevent inflammation by lowering the activity of an immune cell trigger called nuclear factor-kappa B (NF-κB) (vi). Note: anthocyanidins are also available in other higher-potency supplements.
 

Turmeric

A common ingredient in curries, turmeric is a spice that grows in India and Indonesia. It contains an active ingredient called curcumin, which is often recommended as a treatment for reducing pain, inflammation and stiffness. One pilot study has also suggested a curcumin product called BCM-95 may reduce joint pain and swelling in people with active rheumatoid arthritis better than an anti-inflammatory drug called diclofenac (xx). Another study found that curcumin may act as a painkilling and anti-inflammatory agent for the management of rheumatoid arthritis in doses as low as 250mg twice daily (xxi).

High-strength multivitamin and mineral

Multivitamin and mineral supplements that contain that contain antioxidants such as selenium and zinc as well as beneficial levels of vitamins C, D and E may also help support the joints as well as overall health.

Zinc

Taken as a single supplement or as part of a high-strength multivitamin and mineral, zinc is thought to be helpful for maintaining the immune system, which may be affected when you have chronic pain. Some researchers have also shown that blood zinc levels may be significantly lower in people with rheumatoid arthritis compared with the rest of the population (xxii).
 

PEA

Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xxiii), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xxiv) with no known side effects (xxiii).

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xxv). When this happens, PEA supplements may be helpful. In fact a review of 16 clinical trials and meta-analysis of PEA suggests it does have analgesic actions – in other words it helps to relieve pain (xiv).

Meanwhile, natural therapies that may be worth a try include relaxation therapy, magnet therapy and acupuncture.

For even more articles on how to maintain a happier, healthier body, feel free to visit our health library.

 

References:

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14. Rajaei E. et al., The Effect of Omega-3 Fatty Acids in Patients With Active Rheumatoid Arthritis Receiving DMARDs Therapy: Double-Blind Randomized Controlled Trial. Glob J Health Sci. 2015 Nov 3;8(7):18-25. Available online: https://www.ncbi.nlm.nih.gov/pubmed/26925896

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17. European Scientific Cooperative on Phytotherapy Harpagophyti radix (devil's claw). Exeter, UK: ESCOP. 1997:5. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 2. European Scientific Cooperative on Phytotherapy Harpagophyti radix (devil's claw). Exeter, UK: ESCOP. 1997:4. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 2.

18. Nakamura. H, Masuko. K, Yudoh. K, et al. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int. 2006 Sep 5.

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20. Chandran .B, Goel. A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov2012 Nov.

21. Amairaj A. et al., Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study. J Med Food. 2017 Oct;20(10):1022-1030. Available online: https://www.ncbi.nlm.nih.gov/pubmed/28850308

22. Zoli. A, Altomonte. L, et al. Serum zinc and copper in active rheumatoid arthritis: correlation with interleukin 1 beta and tumour necrosis factor alpha. Clin Rheumatol. 1998;17(5):378-82. Xin L. et al., Serum Levels of Copper and Zinc in Patients with Rheumatoid Arthritis: a Meta-analysis. Biol Trace Elem Res. 2015 Nov;168(2):1-10. Available online: https://www.ncbi.nlm.nih.gov/pubmed/25869414

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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