Rheumatoid Arthritis Treatment

This information is part of CreakyJoints’ comprehensive guide for patients living with rheumatoid arthritis. Learn more or download Raising the Voice of Patients: A Patient’s Guide to Living with Rheumatoid Arthritis.

When you have rheumatoid arthritis (RA), you want to make sure you’re getting the right treatments for your symptoms, feeling better, and protecting your joints and organs from possible damage.

You can make sure that you’re receiving the right treatment by working with your rheumatologist to come up with a plan designed for your specific RA. Remember, RA is a specific form of arthritis that is different than degenerative arthritis, which is also known as osteoarthritis, or OA. Your RA journey will not be the same as others with RA. Your disease is personal and it is important to remember that not everyone fits into the same box.

This information should never replace the information and advice from your treating physician. It is meant to inform the discussion that you have with healthcare professionals, as well as others who play a role in your care and well being.

RAISE YOUR VOICE: Your life with your RA is your journey to take. You can and should be involved in every step of decision making about your RA treatment. Never be afraid to speak out, speak up, or ask questions about your treatment plan. Speak up when you’re at your first appointment with your rheumatologist, and at every medical appointment you have. Bring a notebook or with you or use your smartphone’s Notes app to you write down any instructions from your doctor about your treatments, as well as your questions and concerns about your treatments. Write down questions or concerns ahead of time so you can share them or clear up confusion at your appointment. Don’t be shy about asking about the costs of each potential treatment, as well as any possible side effects — including how each drug could affect you or your baby if you or your partner want to get pregnant in the future. While your doctor prescribes your drugs, you’re a full partner in any decisions about your treatment options.

What’s the goal of your rheumatoid arthritis treatment plan?

Most of the time, your doctor will aim for low disease activity or remission. At first, the plan may be to just get your inflammation and RA symptoms under control.

Every person’s RA is different. You won’t start at the same point as other people with this disease. But no matter where your starting point is, you’ll take certain RA treatments in order to reach low disease activity or remission.

We’ll take you through all of your treatment options, including things that you can do in addition to taking drugs, like:

  • Integrative medicine and complementary therapies, including herbs and supplements
  • Exercise, including yoga and aerobic workouts like walking or swimming
  • Diet changes you can make to stay at a healthy weight and protect your heart and joints

The most important part of your treatment plan is you. You’re the one living with RA every day. You’re the one who feels the pain, stiffness, fatigue, and stress that sometimes comes with it. You’re the one who has to manage your life with RA, including taking your meds and juggling appointments. These are the most commonly understood treatments, but research is still being made to improve life with RA. So it is important that you understand enough about RA treatments to make informed decisions, ask questions, and speak up about your healthcare. For example, you may want to:

  • Talk to your rheumatologist or other health professionals about your treatment plan
  • Call your insurance company about which drugs are covered under your policy
  • Meet with to your local legislator or write your member of Congress about healthcare laws

RAISE YOUR VOICE: Don’t wait until side effects become too much to bear to speak up about your treatments. Call, email, or speak to your doctor’s office right away to see if you can change your dose, take your drugs with food to ease nausea, switch drugs, or take another medication along with your drug to ease these effects. Also, if you struggle to afford your treatment copays, coinsurance costs, or payments against your insurance deductible, please contact your doctor’s office, pharmacist, insurance company, or even the drug’s manufacturer to find out if you can get help with these costs. Don’t skip a dose of your medicine or stop taking it before you let your doctor know.

What are rheumatoid arthritis treatment guidelines?

The primary way your rheumatologist or other health professional will design your treatment plan is by following the current RA treatment guidelines. These guidelines are published by the American College of Rheumatology (ACR), the professional association of rheumatologists in the U.S.

Guidelines are usually written and funded by doctors’ associations — what we call the “professional medical societies.” The ACR is the world’s largest society of rheumatologists and rheumatology health professionals. Every two years, guidelines for major types of arthritis, including RA, are updated. Why? So new, important research can be considered by the best arthritis experts, and then they can all agree on how to turn that information into up-to-date recommendations for your arthritis treatment.

You can read the full, published guidelines online. If you find it a little hard to understand, that’s because the RA treatment guidelines are written for doctors and other healthcare professionals.

Leading experts on arthritis create the guidelines as a team. This team or panel includes rheumatologists, rheumatology health professionals, and patients like you. They come up with a final report full of recommendations based on recent scientific information and patient feedback about how best to treat RA. They’re meant to help your doctor make decisions about your prescriptions and other approaches to disease management. They recommend what treatments to use first in most people with RA, and then other options if the first try doesn’t work well enough to lower your disease activity. It’s hard to say how well you may or may not respond to a particular drug. Remember, guidelines are just recommendations. Each person with RA is different and there is no “one size fits all” when it comes to treating RA.

RAISE YOUR VOICE: If your rheumatologist asks you to be a part of a patient focus group or local advocacy event, or even just to answer a patient survey about arthritis treatments, take part if you have time. Even a little information from the patient’s point of view can help influence healthcare policies that benefit you and others who are taking the same journey. Share your opinions, feelings, and advice with other RA patients and their families. You’ll find that you’re part of a caring, powerful community.

How do doctors use the rheumatoid arthritis treatment guidelines?

Your doctor may use the guidelines to decide if and when now is the best time for you to switch treatments — such as if your first treatment doesn’t work well enough to control your inflammation and lower your disease activity score. Guidelines are recommendations — based on the best information on RA treatments available, and updated regularly (every other year).

Who are the rheumatoid arthritis treatment guidelines for?

Guidelines’ recommendations are often used by people who make decisions about how RA is treated, including:

  • Doctors like your rheumatologist or primary-care physician
  • Nurses, nurse practitioners, or physician assistants who treat arthritis patients
  • Insurance company staff who decide which drugs to cover in their formularies
  • Pharmacists who dispense drugs, including at mail-order specialty pharmacies
  • Members of Congress or state legislatures, who vote on drug and healthcare laws

All recommendations for how to treat different types of RA patients are based on evidence. That means the experts who write the guidelines take these important steps:

  • Gather research done at the world’s top hospitals, universities, and labs by the top experts in arthritis, including current studies and data published in top medical journals around the world
  • Read, discuss, and debate all of the evidence on RA treatments in these studies
  • Go over everything from drug side effects, interactions, risks of using treatments in patients with other diseases, ease of using the drug in real life, and even availability and cost
  • Come up with recommendations based on this evidence on how to best treat people with RA

RAISE YOUR VOICE: When you and your healthcare provider decide on a treatment plan, you’re likely to encounter challenges along the way in accessing that care. You will inevitably become familiar with terms like “fail first,” “step therapy,” and “prior authorization,” which all refer to processes established by health insurance companies to manage care to control costs — many times to the detriment of the patient. It is important to understand how these processes work so that you are prepared to advocate for yourself when you speak to your insurance company and doctor — especially if you are denied access to a medication you need. Information can be found online at www.FailFirstHurts.org, as well as from your individual insurance company. GHLF’s advocacy initiative, the 50-State Network, is a coalition of patients that works to bring the patient perspective to state and federal lawmakers considering policies to prevent step therapy, which can wreak havoc on the lives of patients with chronic disease.