RA Treatment: What is the Safest Treatment for Rheumatoid Arthritis? - RheumatoidArthritis.org (2023)

Matthew Ezerioha, MD

Doctor of Medicine (M.D.) in 2016 from Medical University of South Carolina, Expert Medical Consultant & Entrepreneur

Nov 2, 2018 5 min read

Rheumatoid arthritis (RA) has no cure, but doctors recommend that patients adhere to suggested treatments early in diagnosis to decrease the severity of symptoms. There are a variety of treatment methods used to control symptoms and stop joint damage, including medications, surgery, and daily routine and lifestyle changes. Communication with a doctor or rheumatologist is necessary for choosing the most effective treatments. Your physician will ensure that treatments are safe and the medications are prescribed correctly based on each unique situation.

(Video) Rheumatoid arthritis - causes, symptoms, diagnosis, treatment, pathology

Treating RA will not cure the disease, but certain treatments can significantly reduce the pain and prevent permanent damage to the body. Depending on the severity of your symptoms, the goals of treatment will be to gain “tight control” of RA, meaning the disease’s activity is kept steadily at a low level. Keeping RA in “tight control” can prevent long-term joint damage.

These goals primarily focus on:

  • Reducing inflammation
  • Preventing further or permanent damage
  • Improving the quality of life
  • Reducing daily and long-term side effects

Following a strict treatment regimen could bring RA into remission. Remissionmeans that the level of disease activity has decreased in the body. Itis never an indication that symptoms will not return, but following remission, many patients can go for long periods of time without experiencing symptoms.

There are many ways to treat rheumatoid arthritis, and a doctor or rheumatologist can help determine which methods are best for each patient’s individual needs.

These drugs target a particular portion of the disease pathway and help mitigate or control the symptoms of RA. These medications are not a cure, but they may offer patients with RA an opportunity to improve their quality of life by reducing the frequency and intensity of flare-ups.

Medications for RA Treatment

Doctors prescribe medications to reduce inflammation and to relieve joint pain caused by RA. The medications used to treat RA often come with serious side effects, so doctors typically start by prescribing lower doses. The treatment regimen is most beneficial to RA patients who are in the early stages of disease becauseduring this time the symptoms are still relatively subtle.

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Those with advanced stages of RA need more aggressive treatment to reduce inflammation, the time between exacerbations and other effects associated with the condition. This may often require stronger medications to be prescribed. Unfortunately, these drugs often come with more dangerous side effects.

Here are the different medications usually prescribed for rheumatoid arthritis patients:

NSAIDs, or non-steroidal anti-inflammatory drugs, are medications meant to relieve pain and reduce inflammation. They are available over-the-counter, and when needed, stronger doses may be prescribed. Many people are already familiar with NSAIDs because they are used to treat headaches, fevers and other common ailments safely at home. Ibuprofen (Advil, Motrin IB) and naproxen (Aleve) are two basic NSAIDs that will reduce pain and inflammation temporarily.

Weaker NSAIDs come with little side effects or risks but they also only manage symptoms and pain — they will not help with slowing disease activity.

Stronger NSAIDs are available with a prescription and can provide increased pain relief while reducing inflammation throughout the body. NSAIDs with stronger doses come with serious side effects, including:

  • Liver damage
  • Ringing in the ears
  • Heart problems
  • Upset stomach
  • Kidney damage

There are prescription NSAIDs that are safer or gastrointestinal friendlyfor people prone to stomach problems. NSAIDs can be taken orally or applied directly to the joint as a patch or cream.

Corticosteroid medications or another form of drug used in the treatment of RA. Theywork in your body similar to hormones as they try to slow the progression of the disease and stop the immune system from attacking healthy tissue. They can be taken as pills, liquids or given as an injection by a provider. Some of the prescribed forms of corticosteroids includeMethylprednisolone, Prednisolone, and Prednisone. Corticosteroids offer pain relief, but they also come with the potential for side effects.

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Possible side effects include:

  • Leg swelling
  • Weight gain
  • Increased blood pressure
  • Mood swings

Studies have shown that using corticosteroids over long periods of time can result in more serious and permanent side effects. These include:

  • High blood sugar or even diabetes
  • Increased risk of infection
  • Calcium deficiency leading to weak bones
  • Easy bruising on the skin

For this reason, doctors usually only prescribe corticosteroid medications for a short amount of time to reduce symptoms, and then place patients on less dangerous regimens or over-the-counter drugs once symptoms are better controlled.

DMARDs, or disease-modifying antirheumatic drugs, are long-term medications meant to slow or alter the progression of rheumatoid arthritis by stopping the immune system from attacking healthy tissue. These drugs protect joints and tissues from permanent damage and gradually reduce daily pain. DMARDs can be taken with other pain relievers.

Examples of traditional DMARDs are:

  • Methotrexate (Trexall)
  • leflunomide (Arava)
  • Hydroxychloroquine (Plaquenil)
  • Sulfasalazine (Azulfidine)

Side effects are different for each patient and medication, but the most serious are liver damage and susceptibility to infections.

There is a subset of DMARD medications called biologic response modifiers. These drugs target specific parts of the immune system that trigger inflammation that causes joint damage. Blocking TNF inhibitors or the activation of T cellsis one method of preventing the joint damage that frequently occurs in patients who suffer from RA. This greatly reduces the risk of further damage or infection. Biologic agents are typically prescribed in combination with other medications to fight RA symptoms.

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Common biologic agents are:

  • Abatacept (Orencia)
  • Adalimumab (Humira)
  • Anakinra (Kineret)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Rituximab (Rituxan)
  • Tocilizumab (Actemra)

JAK Inhibitors(such as Xeljanz) are another type of DMARDs that work against the pathways that increase the body’s immune response, known as Janus kinase. JAK inhibitors are helpful because they can be taken by mouth, unlike biologics, and they work well with traditional DMARDs. JAK inhibitors can dramatically decrease inflammation.

Physical Therapy

Keeping an active, healthy lifestyle is just as important in treating RA symptoms as the right combination of medications. Exercise may seem too painful, but low-risk exercises like walking and yoga can reduce inflammation. A physical therapist can help you design a safe, effective daily workout routine that will keep joints flexible.

Life with RA is difficult and not being physically able to completecertainroutine tasks may lead to frustration. Physical therapists can help patients learn appropriate exercises and new ways of approaching tasks that minimize the strain on affected joints while improving overall body strength.

Chiropractic Treatment

Often, medication alone cannot alleviate all pain associated with RA. One approach to the chronic pain is seeking the care of a chiropractor. Some medical providers advise caution on chiropractic treatment due to the nature of the body manipulations that could potentially worsen RA pain. However, it has been found to be beneficial to certain RA patients. Patients should be cautioned not to receive care from chiropractors when active swelling or RA flare-ups occur, as this could worsen the condition. Make sure to speak with your primary doctor before pursuing any additional, specialized interventions such as chiropractic treatment.


Surgery is not the standard of care in the treatment of RA. Surgical management is usually reserved for those with severe joint damage and should always occur in conjunction with the consultation of a rheumatologist. As mentioned before, RA is an inflammatory condition that ultimately leads to joint destruction and is a disease that can accelerate the natural course of joint damage that often occurs with aging. There is no cure, ability to restore damage or fix the deformities caused by RA. However, surgery potentially enables patients to regain function by repairing the joint damage that frequently occurs with this condition. The overall goal of surgery, when deemed appropriate, is to improve the quality of life of those affected.

There are three surgical procedures that RA patients typically receive. These are:

(Video) Symptoms and Treatment for Rheumatoid Arthritis patients.

  • Joint replacement — surgeons remove part of your damaged joint and insert a prosthetic (artificial)replacement
  • Joint fusion — when replacements aren’t possible, surgeons can fuse and realign joints
  • Tendon repair — over time, inflammation can damage tendons. Surgeons can fix these damaged tendons, to enable easier movement.

For more information on managing Rheumatoid Arthritis and improving symptoms, visit our Living with RA section.


What is the safest rheumatoid arthritis medication? ›

Methotrexate is widely regarded as one of the safest of all arthritis drugs, though it carries some potential downsides. Gastrointestinal symptoms such as nausea and vomiting are its most frequent side effects.

What is the most successful treatment for rheumatoid arthritis? ›

Conventional DMARDs .

These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

Which is the safest biologic for RA? ›

What is the safest biologic for rheumatoid arthritis? All biologics carry a risk of side effects such as infection. However, research has found that Abatacept carries a lower risk of serious infection than other biologics for RA.

What is the most effective anti inflammatory for rheumatoid arthritis? ›

This risk is lowest when using naproxen, so naproxen is the most suitable NSAID for people who have both rheumatoid arthritis and a cardiovascular disease.
Examples of these drugs include:
  • celecoxib.
  • diclofenac.
  • etoricoxib.
  • ibuprofen.
  • naproxen.
May 20, 2020

What is the number one medication for rheumatoid arthritis? ›

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain.

What are the best medications for rheumatoid arthritis with least side effects? ›

Hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) are used for mild rheumatoid arthritis. They are not as powerful as other DMARDs, but they usually cause fewer side effects.

What is the newest treatment for RA? ›

New Treatments for Rheumatoid Arthritis - Latest FDA Approvals
DrugDrug Class
golimumab (Simponi)tumor necrosis factor (TNF) blocker
rituximab (Rituxan)CD20-directed cytolytic antibody
abatacept (Orencia)selective T cell costimulation modulator
adalimumab (Humira)tumor necrosis factor (TNF) blocker
12 more rows

What is the first line treatment for rheumatoid arthritis nice? ›

For adults with newly diagnosed active RA: Offer first-line treatment with cDMARD monotherapy using oral methotrexate, leflunomide or sulfasalazine as soon as possible and ideally within 3 months of onset of persistent symptoms.

Can you stop RA from getting worse? ›

There is no cure for rheumatoid arthritis (RA), but remission can feel like it. Today, early and aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) and biologics makes remission more achievable than ever before.

Which RA biologic has the least side effects? ›

The RA drug with the least side effects is hydroxychloroquine (Plaquenil). “We don't consider it immunosuppressive, and it doesn't cause elevated liver markers or kidney issues like some of the other drugs,” says Dr. Sharmeen.

How do you treat RA without biologics? ›

Natural remedies
  1. Stretching. Stretching the muscles around the affected joints can provide some relief from RA symptoms. ...
  2. Exercise. ...
  3. Heat and cold. ...
  4. Balanced rest. ...
  5. Stress relief. ...
  6. Cognitive behavioral therapy. ...
  7. Support groups. ...
  8. Assistive devices.

What is an alternative to hydroxychloroquine for rheumatoid arthritis? ›

Methotrexate. Methotrexate is a DMARD used to treat rheumatoid arthritis, juvenile idiopathic arthritis, vasculitis and psoriatic arthritis.

What is the safest anti-inflammatory for long term use? ›

Among traditional nonselective NSAIDs, diclofenac represents the greatest cardiovascular risk. In contrast, naproxen seems to have the safest cardiovascular profile and is the best treatment option in patients with high cardiovascular risk.

What is the safest anti-inflammatory drug for arthritis? ›

They may suggest a different NSAID or other drug. For example, celecoxib is considered safe for long-term arthritis pain. It does less damage to the stomach than other NAIDs.

Which medication is preferred to treat most patients with rheumatoid arthritis? ›

Methotrexate. Methotrexate is now considered the first-line DMARD agent for most patients with RA. It has a relatively rapid onset of action at therapeutic doses (6-8 weeks), good efficacy, favorable toxicity profile, ease of administration, and relatively low cost.

Can you live with rheumatoid arthritis without medication? ›

Can you live with rheumatoid arthritis without medication? Since RA is a progressive disease, you cannot live with it without medical treatment. If you do, the symptoms will gradually get worse and become disabling. There are some natural remedies that you can use to help with some symptoms relief.

What is the new arthritis drug 2022? ›

The new drug olokizumab is a humanised monoclonal antibody that directly targets the interleukin-6 cytokine. This is a messenger molecule that, like TNF, activates inflammatory responses in the body and is involved in the progression of joint damage in rheumatoid arthritis.

What climate is best for rheumatoid arthritis? ›

But based on research, it appears that for most people with arthritis, a warmer, drier climate may be optimal, such as that in parts of Texas, Arizona, Nevada and the Eastern Sierra region of California.

What can worsen rheumatoid arthritis? ›

Overexertion, poor sleep, stress or an infection like the flu can all set off RA symptoms. With a predictable flare you'll temporarily feel worse, but your symptoms will resolve in time. Unpredictable flares have more uncertainty associated with them.

How do I stop RA from progressing? ›

Being on a DMARD or biologic therapy for RA is the best way to prevent progression,” Dr. Lally says. Disease-modifying anti-rheumatic drugs (DMARDs) are usually the first line in medication. “Methotrexate [a DMARD] is the anchor drug for rheumatoid arthritis,” Dr.

Is hydroxychloroquine safer than methotrexate? ›

Conclusions: In older patients with rheumatoid arthritis, hydroxychloroquine and methotrexate showed similar SCA/VA and MACE risks; however, hydroxychloroquine initiators with history of HF had higher risks of MACE, cardiovascular mortality, all-cause mortality, and myocardial infarction.

Can vitamin D reverse rheumatoid arthritis? ›

Vitamin D can play a role is easing some of the symptoms related to rheumatoid arthritis, but it is by no means a panacea. You still need your medication and other forms of therapy to keep the disease under control.

What not to do during an RA flare up? ›

Balance Rest and Activity

But try not to stay in bed for more than a day or two. Spending too much time lying on the bed or sofa will make you stiff and increase your pain. Once you start to feel a bit better, get up, stretch, go for a walk, and continue with as many of your usual activities as possible.

What slows down rheumatoid arthritis? ›

Conventional synthetic disease-modifying antirheumatic drugs (DMARDs), primarily methotrexate, may be the first medication you are prescribed to slow disease activity in RA. Other DMARDs used in RA treatment include leflunomide, hydroxychloroquine and sulfasalazine. Sometimes two or more DMARDs are used together.

What percentage of RA patients take biologics? ›

For the small percentage of patients not on DMARDs or biologics, reasons included disease remission, refusal of treatment, and contraindications to DMARD or biologic therapy. In any given year, between 93.3% and 94% of patients were on a DMARD and/or biologic agent.

What are the dangers of biologics? ›

Allergic reactions with a biologic infusion may result in shortness of breath, chills, redness, itchiness, itchy eyes, or itchy lips. If your medication is given through an injection, you may see a reaction at the injection site where they needle puncture is.

What is the once a month injection for rheumatoid arthritis? ›

What Is SIMPONI® (golimumab)? SIMPONI® is the only anti-TNF with just one injection each month for adults with: moderate to severe rheumatoid arthritis (RA), with the medicine methotrexate. active psoriatic arthritis (PsA), alone or with the medicine methotrexate.

What vitamins help rheumatoid arthritis? ›

Vitamin B6: Research seems to show inflammation from RA lowers B6 levels which in turn makes the inflammation worse. In addition, the NSAIDs that many people use to treat their inflammation lowers B6 levels in people with RA.

What helps inflammation from rheumatoid arthritis naturally? ›

20 Remedies for Rheumatoid Arthritis Flare-Ups
  1. Rest and relaxation.
  2. Exercise.
  3. Yoga.
  4. Tai chi.
  5. Acupuncture.
  6. Massage.
  7. Mindfulness.
  8. Support groups.
Mar 6, 2020

What is the downside of taking hydroxychloroquine? ›

Serious side effects

muscle weakness, cramps, stiffness or spasms, or changes in how your skin feels such as tingling. frequent infections with a high temperature, sore throat or mouth ulcers. bruising that happens more easily than usual.

Which is better for rheumatoid arthritis methotrexate or hydroxychloroquine? ›

Otrexup (methotrexate) is the first-choice treatment for many types of cancer and arthritis, but it has many side effects. Plaquenil (hydroxychloroquine) has been shown to improve physical function in up to 80% of patients with rheumatoid arthritis.

Can I stop taking hydroxychloroquine for RA? ›

But it's important to note that if you're taking Plaquenil to treat RA or lupus, your symptoms may get worse if you stop the drug. Because Plaquenil reduces symptoms of these conditions, stopping it could cause symptoms to worsen or come back.

What can I take long term for inflammation? ›

Drugs that are anti-inflammatory

If you're on the hunt for an anti-inflammatory, Tylenol or acetaminophen is not the drug for you. Instead, look into ibuprofen, naproxen, and aspirin. These are all examples of anti-inflammatory drugs or NSAIDs.

Who should not take anti-inflammatory drugs? ›

NSAIDs are generally not recommended for people with kidney disease, heart failure, or cirrhosis, or for people who take diuretics. Some patients who are allergic to aspirin may be able to take selective NSAIDs safely, although this should be discussed in advance with a health care provider.

What happens if you take anti-inflammatory for too long? ›

Older adults commonly take nonsteroidal anti-inflammatory drugs (NSAIDs) chronically. Studies of older adults show that chronic NSAID use increases the risk of peptic ulcer disease, acute renal failure, and stroke/myocardial infarction.

What is the best anti-inflammatory in the world? ›

Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available.

What is the strongest non prescription anti-inflammatory? ›

Naproxen. Naproxen (Aleve) is the most powerful anti-inflammatory pain reliever available without a prescription. It is especially effective for sprains, sunburns and arthritis and other conditions. Similar doses of Naproxen tend to last longer than other non-prescription pain relievers.

What is a good anti-inflammatory that is not an Nsaid? ›

In addition, certain supplements can help provide relief from inflammation and pain. Common alternatives to NSAIDs include arnica, curcumin, and bromelain. Topical pain reliers—like capsaicin cream—may also help to provide relief.

What is the gold standard treatment for rheumatoid arthritis? ›

The current gold standard treatment for rheumatoid arthritis combines a monoclonal antibody and TNF (tumor necrosis factor) inhibitor called adalimumab with a folic acid antagonist called methotrexate. It is most effective for patients who do not respond to methotrexate alone.

What is the safest biologic for rheumatoid arthritis? ›

What is the safest biologic for rheumatoid arthritis? All biologics carry a risk of side effects such as infection. However, research has found that Abatacept carries a lower risk of serious infection than other biologics for RA.

What is the new pill for rheumatoid arthritis? ›

New Treatments for Rheumatoid Arthritis - Latest FDA Approvals
DrugDrug Class
rituximab (Rituxan)CD20-directed cytolytic antibody
abatacept (Orencia)selective T cell costimulation modulator
adalimumab (Humira)tumor necrosis factor (TNF) blocker
anakinra (Kineret)interleukin-1 receptor antagonist
12 more rows

What is the new treatment for rheumatoid arthritis 2022? ›

Olokizumab, a new treatment for rheumatoid arthritis, may be as effective as current “gold standard” treatments, according to results from a phase 3 clinical trial published in the New England Journal of Medicine.

What is the new medication for rheumatoid arthritis 2022? ›

The new drug olokizumab is a humanised monoclonal antibody that directly targets the interleukin-6 cytokine. This is a messenger molecule that, like TNF, activates inflammatory responses in the body and is involved in the progression of joint damage in rheumatoid arthritis.

What is second line treatment for rheumatoid arthritis? ›

A common approach when additional therapy is needed is to add a tumor necrosis factor (TNF) inhibitor to the methotrexate, which is usually effective in most patients, according to Elena Myasoedova, MD, PhD, of the Mayo Clinic in Rochester, Minnesota.

What is the safest anti-inflammatory medication to take long term? ›

Of the available NSAIDs, ibuprofen seems to present the lower risk of liver injury and may be a preferred option for patients with risk factors for hepatotoxicity.

Which arthritis meds have the least side effects? ›

The RA drug with the least side effects is hydroxychloroquine (Plaquenil). “We don't consider it immunosuppressive, and it doesn't cause elevated liver markers or kidney issues like some of the other drugs,” says Dr. Sharmeen.

What triggers RA flare ups? ›

Flare Types and Triggers

Overexertion, poor sleep, stress or an infection like the flu can all set off RA symptoms. With a predictable flare you'll temporarily feel worse, but your symptoms will resolve in time. Unpredictable flares have more uncertainty associated with them.


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