Treatments for Rheumatoid Arthritis

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Alternative Therapies
Vagus Nerve Stimulation


Photo of costumes and hatsTreatments for rheumatoid arthritis include medications such as immunosuppressants and biologics, alternative therapies, supplements, and exercise.

Many patients respond to a combination of medication and alternative therapies.

Pain management is very important in rheumatoid arthritis, in order to maintain productivity and quality of life. Aspects of pain management may include medications as well as lifestyle adjustments such as stress reduction, pacing, and meditation.

Anti-interleukin-1 treatment in patients with rheumatoid arthritis and type 2 diabetes (TRACK): A multicentre, open-label, randomised controlled trial. Our results suggest the concept that IL-1 inhibition may be considered a targeted treatment for RA and T2D. PubMed, PLoS Med, 2019 Sep 12;16(9):e1002901. (Also see Treatments for Diabetes)

Emerging therapies in rheumatoid arthritis (RA): focus on monoclonal antibodies. Advances in the treatment of RA are attributed to several aspects such as new classification criteria as well as better understanding of the pathogenesis of RA. PubMed, F1000Res, 2019 Aug 30;8.

Intensive management for moderate rheumatoid arthritis: a qualitative study of patients' and practitioners' views. Some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients. PubMed, BMC Rheumatol, 2019 Mar 28;3:12.

Predictors of Treatment Response in Rheumatoid Arthritis. This review article discusses the approaches used to identify theranostic biomarkers and to present an overview of currently available biomarkers and of their performance. PubMed, Joint Bone Spine, 07/04/2018.

Long–term disease and patient–reported outcomes of a continuous treat–to–target (T2T) approach in patients with early rheumatoid arthritis in daily clinical practice. Continuous application of T2T in real–life RA patients leads to favourable disease–related and patient–related outcomes. PubMed, Clin Rheumatol, 02/01/2018.

Cysteine-rich 61 (Cyr61) participates in the pathogenesis of rheumatoid arthritis (RA) via promoting MMP-3 expression by fibroblast-like synoviocytes. This study provides new evidence that Cyr61 participates in RA pathogenesis not only as a pro–inflammatory factor but also plays a key role in bone erosion via promoting MMP-3 expression. PubMed, Mod Rheumatol. (Also see Antibodies)

Rheumatoid Arthritis Treatments. It is essential that the patient and the patient's family be educated about the nature and course of the disease. The major goals of treatment of the arthritis are to reduce pain and discomfort, prevent deformities and loss of joint function, and maintain a productive and active life. Johns Hopkins University.

Alternative Therapies

Psychosomatic Features, Compliance, and Complementary Therapies in Rheumatoid Arthritis. Current data about efficacy of the additional correcting therapies for patients with rheumatoid arthritis, both emerging and common ones, are discussed in the review. PubMed, Curr Rheumatol Rev, 12/11/2019.


Aerobic Exercise and Fatigue in Rheumatoid Arthritis (RA) Participants: A Meta–Analysis Using the Minimal Important Difference Approach. Land–based aerobic exercise is associated with statistically significant reductions in fatigue; however, it may be unlikely that a substantial number of participants with RA could obtain clinically relevant reductions in fatigue. PubMed, Arthritis Care Res (Hoboken), 2018 Dec;70(12):1735-1739.


Like many rheumatic diseases, not all rheumatoid arthritis patients respond to the same medication; therefore, patients try several different medications in hopes that one will eventually relieve their symptoms and slow the progression of the disease.

Investigation of genetically regulated gene expression and response to treatment in rheumatoid arthritis highlights an association between IL18RAP expression and treatment response. Our results suggest that IL18RAP expression is worthy of further investigation as a potential predictor of treatment response in rheumatoid arthritis. PubMed, Ann Rheum Dis, 2020 Nov;79(11):1446-1452. (Also see Interleukins)

Risk of malignancy with non-TNFi biologic or tofacitinib therapy in rheumatoid arthritis: A meta-analysis of observational studies. Among RA patients, a small statistically significant increase in developing cancer was observed for abatacept exposure. Seminars in Arthritis and Rheumatism, 09/03/2020. (Also see Biologic Agents)

Comparative Persistence of Methotrexate (MTX) and Tumor Necrosis Factor Inhibitors (TNFi) in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. Concomitant use of MTX with a TNFi, however, is associated with improved TNFi persistence in all 3 diseases. PubMed, J Rheumatol, 2020 Jun 1;47(6):826-834. (Also see Psoriasis and Psoriatic Arthritis, Ankylosing Spondylitis and Immunosuppressants)

Implication of Baseline Levels and Early Changes of C-reactive Protein (CRP) for Subsequent Clinical Outcomes of Patients With Rheumatoid Arthritis (RA) Treated With Tocilizumab. CRP and its early course may inform, to some extent, the estimation of potential therapeutic success in patients with RA. PubMed, Ann Rheum Dis, 05/05/2020. (Also see Clinical Trials)

Comparative Risk of Cardiovascular Events (MACE) With Biologic and Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs) in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Based on meta-analysis, as compared to tumor necrosis factor inhibitors, tocilizumab may be associated with a reduced risk of MACE, whereas csDMARDs may be associated with an increased risk of MACE and stroke. PubMed, Arthritis Care Res (Hoboken), 2020 Apr;72(4):561-576. (Also see DMARDs)

Clinical and Structural Efficacy of Hydroxychloroquine (HCQ) in Rheumatoid Arthritis (RA): A Systematic Review. Combining HCQ with other DMARDs could provide some clinical improvement in patients with RA. PubMed, Arthritis Care Res (Hoboken), 2020 Jan;72(1):36-40. (Also see DMARDs)

Effects of Sarilumab on Rheumatoid Arthritis (RA) as Reported by Patients Using the Rheumatoid Arthritis Impact of Disease (RAID) Scale. Based on the RAID, sarilumab + csDMARD or as monotherapy reduced the effect of RA on patients' lives to a greater extent than placebo + csDMARD or adalimumab monotherapy. PubMed, J Rheumatol, 2019 Oct;46(10):1259-1267.

Tocilizumab and the Risk of Cardiovascular Disease (CVD): Direct Comparison Among Biologic Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis (RA) Patients. Tocilizumab was associated with a CVD risk comparable to that for etanercept as well as a number of other biologics used for the treatment of RA. PubMed, Arthritis Care Res (Hoboken), 2019 Aug;71(8):1004-1018. (Also see Clinical Trials)

Tapering biologic therapy for people with rheumatoid arthritis in remission: A review of patient perspectives and associated clinical evidence. More research is needed on tapering biologics, and should include studies of patient perspectives as well as health economic evaluations. PubMed, Musculoskeletal Care, 05/30/2019.

Pharmacodynamic biomarkers and differential effects of TNF- and GM-CSF-targeting biologics in rheumatoid arthritis. Our results revealed golimumab- and mavrilimumab-specific pharmacodynamic biomarkers, and demonstrated differential biomarker-treatment relationships in anti-TNF-IR and DMARD-IR patients, respectively. PubMed, Int J Rheum Dis, 2019 Apr;22(4):646-653. (Also see Biologic Agents)

Brief Report: Safety and Immunogenicity of Rituximab Biosimilar GP 2013 After Switch From Reference Rituximab in Patients With Active Rheumatoid Arthritis. No safety risks were detected when patients switched from reference RTX to GP2013. PubMed, Arthritis Care Res (Hoboken), 2019 Jan;71(1):88-94. (Also see Biologic Agents)

Association between autophagy and inflammation in patients with rheumatoid arthritis (RA) receiving biologic therapy. Elevated autophagy with significant correlation to inflammation suggests the involvement of autophagy in RA pathogenesis. PubMed, Arthritis Res Ther, 2018 Dec 5;20(1):268. (Also see Biologic Agents)

The effects of methotrexate (MTX) and hydroxychloroquine (HCQ) combination therapy vs methotrexate monotherapy in early rheumatoid arthritis (RA) patients. In contrast to indirect comparison review data, MTX–HCQ seems somewhat more effective after 6 months than MTX monotherapy in early RA patients. PubMed, Rheumatology (Oxford), 2019 Jan 1;58(1):131-134. (Also see DMARDs)

Predictors of disease activity and structural progression after treatment with adalimumab plus methotrexate or continued methotrexate monotherapy in patients with early rheumatoid arthritis. Findings suggested a relationship between the addition of adalimumab at 6 months after methotrexate failure and improved outcomes. PubMed, Ann Rheum Dis, 08/03/2018. (Also see Immunosuppressants)

Ability of disease–modifying antirheumatic drugs to prevent or delay rheumatoid arthritis (RA) onset: a systematic literature review and meta–analysis (MA). This MA demonstrates that early therapeutic intervention may significantly reduce the risk of RA onset in this very first phase of the disease. PubMed, Ann Rheum Dis, 06/08/2018. (Also see DMARDs)

Resveratrol (RSV) as an effective adjuvant therapy in the management of rheumatoid arthritis: a clinical study. It was found that the clinical markers and the disease activity score assessment for 28 joints were significantly lowered in the RSV–treated group. PubMed, Clin Rheumatol, 04/03/2018.

Safety and efficacy of alternate–day corticosteroid treatment (QOD CS) as adjunctive therapy for rheumatoid arthritis (RA) : a comparative study. QOD CS treatment leads to a lower infection rate and less CS dependence than does daily treatment and both RA treatments are equally effective. PubMed, Clin Rheumatol, 03/26/2018.

Residual disease activity (RDA) in rheumatoid arthritis (RA) patients treated with subcutaneous biologic drugs that achieved remission or low disease activity (LDA). RDA in RA was present even in patients with remission or LDA, especially for the patient's reported outcome and impaired function was also present in a significantly rate of patients. PubMed, Clin Rheumatol, 02/21/2018. (Also see Biologic Agents)

Infliximab has no apparent effect in the inner ear hearing function of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Our study showed that there was no notable change or deterioration in the hearing function of the patients with AS and RA who were treated with infliximab. PubMed, Clin Rheumatol.


Efficacy and safety of rituximab (RTX) in peripheral ulcerative keratitis (PUK) associated with rheumatoid arthritis (RA). RTX appears to be an efficient and safe therapeutic option in the treatment of RA-associated PUK. PubMed, RMD Open, 2021 Jan;7(1):e001472. (Also see Biologic Agents)


Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population-based cohort study. RF-positive but not RF-negative patients were at increased risk of cardiovascular events following exposure to glucocorticoids. Wiley, Arthritis and Rheumatism, Vol 56, Issue 3, Pages 820-830. (Also see Medications)


Disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis. DMARDS reduce pain, swelling and stiffness over a period of weeks or months by slowing down the disease and its effects on your joints. Arthritis Research UK.


Thymidylate synthase (TYMS) polymorphisms and responsiveness to or toxicity of methotrexate (MTX) in rheumatoid arthritis (RA). This meta–analysis demonstrates that the TYMS 2R/3R and 6 bp I/D polymorphisms may not be associated with non–responsiveness to or toxicity of MTX therapy in RA patients. PubMed, Z Rheumatol, 01/29/2018. (Also see Methotrexate)


Radioscapholunate arthrodesis versus radiolunate arthrodesis in rheumatoid wrist surgery: clinical and radiographic outcomes. Our results have shown that radiolunate arthrodesis remains a reliable surgical procedure for advanced rheumatoid wrist. PubMed, Hand Surg Rehabil, 04/22/2020.

Long–term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis (RA). Our original patient–reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long–lasting benefits in RA patients and pain relief was the most favorable effect. PubMed, Int J Rheum Dis, 09/05/2018.

National trends and in–hospital outcomes in patients with rheumatoid arthritis (RA) undergoing elective atlantoaxial spinal fusion (AASF) surgery. In–hospital morbidity and mortality rates of AASF in RA patients were higher than those of other major orthopaedic surgeries in RA patients and respiratory management is particularly important after AASF. PubMed, Clin Exp Rheumatol.

Vagus Nerve Stimulation

Divergence of neuroimmune circuits activated by afferent and efferent vagal nerve stimulation (VNS) in the regulation of inflammation. Our findings indicate that intact VNS activates at least two distinct neuroimmune circuits each with unique mechanisms of action. PubMed, J Physiol, 01/25/2021.

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