Rheumatoid Arthritis Treatment Options

Rheumatoid arthritis is a chronic inflammatory autoimmune disease. Despite affecting approximately 1% of the global population, the condition has no known cure, with most traditional treatment options focused instead on slowing disease progression, relieving pain and inflammation, and preserving function.

At the same time, these treatment options can be limited and are often at their most effective when the condition is caught early. The early “window of opportunity” for treatment is often considered to be within the first 3 to 6 months after symptom onset, and when left untreated, can lead to irreversible joint damage.

In recent years, there have been significant advances in the treatment of rheumatoid arthritis, with the introduction of newer modalities and approaches. While many of these remain experimental, early research is exploring a potential shift from treating symptoms alone to addressing immune activity involved in the disease.

With that in mind, this article breaks down the main standard, supportive, and emerging rheumatoid arthritis treatment options, though patients should still consult a medical professional before deciding on the best course of treatment.

DMARDs (Disease-Modifying Antirheumatic Drugs) are commonly prescribed after a rheumatoid arthritis diagnosis. These drugs help interrupt the inflammatory processes that damage joints, reducing symptoms and slowing disease progression by helping prevent further damage to nearby bones, tendons, ligaments, and cartilage.

Physicians may prescribe one DMARD or a combination of DMARDs. Common options include:

• Methotrexate
• Hydroxychloroquine
• Sulfasalazine
• Leflunomide

Methotrexate is commonly used as the first-line DMARD, often in combination with another DMARD and a short course of corticosteroids to help relieve joint pain while longer-term treatment begins to take effect.

Methotrexate and other DMARDs can take several weeks or months to show their full effects. Methotrexate may cause side effects such as:

• feeling sick
• loss of appetite
• a sore mouth
• diarrhoea
• headaches
• hair loss

Methotrexate can also affect the liver and blood cells, which is why patients usually require regular monitoring during treatment.

Biological treatments are complex medications derived from living cells or biological processes. They are often offered in combination with other DMARDs, but usually only in cases where traditional DMARDs have not been effective on their own.

These treatments are typically administered by injection or infusion. They work by targeting the chemicals, cells, or immune pathways directly involved in inflammation.

Some common biologic therapies and treatment classes for RA include:

• Adalimumab
• Etanercept
• Infliximab
• TNF (tumor necrosis factor) inhibitors
• IL-6 inhibitors
• B-cell targeted therapies
• T-cell costimulation blockers
• Other interleukin-targeted therapies

Because biological treatments affect immune system activity, they can also carry the risk of additional side effects. These may include infections, fever, headaches, injection or infusion reactions, and the potential reactivation of previous infections.

JAK inhibitors are newer targeted oral treatments for rheumatoid arthritis. Like biological treatments, these medicines are targeted therapies that work by inhibiting the immune signalling pathways involved in inflammation. However, unlike biologic treatments, JAK inhibitors are taken as tablets.

Common side effects may include, though they may not occur at all:

• Upper respiratory tract infections, including infections of the nose, throat, or windpipe
• Lung infections, including pneumonia and bronchitis
• Shingles
• Influenza
• Bladder infection, also known as cystitis
• Increased liver enzymes or muscle enzymes in the blood, which may be signs of liver or muscle problems
• High levels of blood fat, including cholesterol, shown by blood test

Additional potential risks include major cardiovascular problems, such as heart attacks or strokes, cancer, blood clots in the lungs or deep veins, and serious infections.

Because these medications require careful risk assessment and monitoring, JAK inhibitors are usually considered after specialist review, particularly when other rheumatoid arthritis treatments have not been effective or suitable.

In some cases, patients with rheumatoid arthritis are advised to use a combination of painkillers and anti-inflammatory medications.

Painkillers, such as paracetamol and codeine combinations like co-codamol, can help relieve pain associated with the condition, but they do not treat joint inflammation.

Meanwhile, anti-inflammatory drugs can be taken to reduce inflammation and relieve pain. These can include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and diclofenac. However, NSAIDs do not stop rheumatoid arthritis from getting worse over time.

Steroids can also be prescribed to help reduce pain, stiffness, and inflammation, but are often only used for short-term relief. This is because extended use can lead to serious side effects, such as:

• weight gain
• osteoporosis, or weakening of the bones
• easy bruising
• muscle weakness
• thinning of the skin
• increased blood pressure

Because they focus on pain and inflammation relief, these treatment options are often used to alleviate symptoms while waiting for DMARDs or other treatments to take effect.

While medication is often central to treating the inflammatory mechanisms behind rheumatoid arthritis, physical and occupational therapy can be used as supportive treatment.

Regular exercise can improve physical capacity in RA patients, help preserve joint mobility, reduce stiffness, and maintain independence.

A physical therapist can create a personalized exercise program based on rheumatoid arthritis symptoms, mobility, and disease activity, with physical therapy plans often including:

• Low-impact exercise
• Stretching and mobility work
• Strength training
• Assistive devices
• Braces or splints
• Joint protection strategies
• Heat and cold therapy

While physical therapy does not treat the underlying autoimmune disease itself, it can be an important component of managing symptoms and maintaining function as the condition progresses.

Lifestyle changes may help support rheumatoid arthritis management, but should not replace medical treatment.

These can include:

• Anti-inflammatory diet patterns
• Weight management
• Smoking cessation
• Sleep support
• Stress management

Some supplements and complementary therapies may help manage symptoms. However, evidence for many is limited, and some may interact with rheumatoid arthritis medications. Patients should always consult their physician before adding supplements, making major dietary changes, or incorporating alternative therapies into their treatment plan.

In some advanced cases of rheumatoid arthritis, surgery may be required to reduce pain or restore joint function.

While DMARDs and other treatment approaches are meant to help slow the progression of the condition, joint damage can still occur despite medication. Surgery is usually considered when medication-based and conservative treatments have not provided enough relief.

Depending on the joint affected and the severity of the damage, surgical options may include:

• Hand and wrist surgery to correct deformities or tendon damage
• Synovectomy, sometimes performed arthroscopically, to remove inflamed joint tissue
• Joint fusion to stabilize damaged joints and reduce pain
• Arthroplasty to replace part or all of an affected joint

However, surgery does not treat the underlying autoimmune disease, which means ongoing rheumatoid arthritis management may still be needed after surgery.

Rheumatoid arthritis treatment continues to evolve as researchers learn more about immune pathways involved in inflammation. For patients with persistent symptoms, medication side effects, or an incomplete response to standard treatment, this may support a more individualized review instead of abandoning standard care.

One area of development is precision diagnostics and individualized treatment planning, which aims to select and adjust treatment based on the patient’s disease characteristics. This may include factors such as:

• Biomarker testing
• Advanced imaging
• Disease activity
• Treatment history
• Previous medication response

These tools may help physicians identify the most appropriate treatment options for each patient and avoid ineffective therapies sooner.

Other emerging directions include new immune-targeting therapies, combination treatment strategies, and regenerative medicine research.

Stem Cell and Regenerative Medicine Research

Among these emerging directions, stem cell-based therapy is one approach being explored for the treatment of rheumatoid arthritis.

However, stem cell therapy for rheumatoid arthritis is still experimental and should not replace standard first-line care. Instead, it is being studied as a potentially disease-modifying approach that may be considered alongside conventional treatment after individual medical review.

The rationale for stem cell-based therapy in RA is based on several disease-relevant processes. Rather than focusing only on temporary pain relief, research is exploring whether stem cell-based approaches may help:

• Regulate inflammatory activity
• Modulate immune responses
• Support tissue and joint repair processes

Much of this research focuses on mesenchymal stem cells (MSCs). In addition to their potential role in tissue repair, MSCs release soluble signalling factors known as paracrine factors. These factors are also associated with the stem cell secretome, including extracellular vesicles and exosomes.

At ANOVA-IRM, stem cell secretome is used for the broader autoimmune and inflammatory aspects of rheumatoid arthritis while combining treatment with bone marrow concentrate (BMC) to target degradation in specific joints that are already affected.

For RA, the research focus is not simply to rebuild damaged joints. The broader question is whether stem cell- and secretome-based approaches may influence the inflammatory and immune responses involved in the disease.

Any clinical use should still be considered experimental. Suitability depends on individual medical review, and no responsible clinic should guarantee results.

If standard rheumatoid arthritis treatment has not provided enough relief, or you are curious about stem cell-based therapy, you can schedule an appointment with our medical specialists to discuss the potential benefits and risks for your case.

At ANOVA-IRM, we offer personalized treatment planning that may combine established therapies with novel regenerative medicine approaches when appropriate. Each case is reviewed individually before experimental options are considered.

Contact ANOVA to request an individual case review.