Treating Rheumatoid Arthritis

The goals of treatment are to relieve pain, reduce inflammation, maintain function, and prevent joint damage and systemic illness. There is no cure for rheumatoid arthritis, but disease-modifying antirheumatic drugs (DMARDs) can help produce long-term remission.

Assessing prognosis

Most people with rheumatoid arthritis are treated with a combination of drugs. Deciding which drugs to use involves an assessment of your predicted disease progression (prognosis).

To determine your prognosis, the doctor will take into consideration your age when the disease began, rheumatoid factor level, sed rate, number of swollen joints and the presence of certain systemic conditions, such as rheumatoid nodules, Sjögren’s syndrome, scleritis, vasculitis, pericarditis or Felty’s syndrome.

People who develop rheumatoid arthritis before age 40 and have high levels of rheumatoid factor, an elevated sed rate, more than 20 swollen joints and one or more systemic conditions are considered to have a poor prognosis. Studies demonstrate that these individuals have more than a 70 percent chance of developing joint damage or joint erosions within two years of disease onset. Thanks to the advent of disease-modifying drugs, however, an unfavorable prognosis does not mean an inevitable downward spiral.

The long-term prognosis for people with rheumatoid arthritis also depends on controlling the other conditions that may develop. Individuals who have rheumatoid arthritis have a shorter life span than the general population, largely because of an increased risk of coronary heart disease and infection (especially lung infection). Another health concern is osteoporosis, which is a common complication of rheumatoid arthritis. Evidence also suggests that rheumatoid arthritis may increase the risk of developing certain cancers. If you have rheumatoid arthritis, talk to your doctor about what steps you need to take to prevent, detect and treat these diseases.

Measuring treatment effects

After you have taken your medication for several weeks, your doctor will repeat the same tests and assessments used to establish your baseline. Repeating the tests will help the doctor assess the treatment’s effectiveness.

The American College of Rheumatology (ACR) has developed a scoring system that doctors use to rate any changes. The ACR standard for a 20 percent “clinical improvement” (referred to as ACR 20) requires 20 percent improvement in the count of tender and swollen joints and 20 percent improvement in at least three of the following measures:

• Your assessment of pain

• Your global assessment of disease activity

• Your physician’s global assessment of your disease activity

• Your assessment of physical function

• Your sed rate or other markers of inflammation

The same criteria are used to identify improvements of 50 to 70 percent (known as ACR 50 and ACR 70, respectively). The maximum level of improvement is referred to as a complete remission.

A complete remission occurs when you no longer have any of the following signs or symptoms of disease:

• Symptoms of active inflammatory joint pain

• Morning stiffness

• Fatigue

• White blood cells in the synovial fluid

• Progression of joint damage (as judged by X-rays taken at each examination and compared with baseline X-rays)

• Elevated sed rate or C-reactive protein levels

At an ACR 20 rating, you may notice a modest improvement in your arthritis symptoms. If you reach an ACR 50 or ACR 70 rating, you will definitely experience a meaningful, positive change. If you achieve complete remission, you may feel as if you never had rheumatoid arthritis. Unfortunately, these improvements may not be permanent.

(Originally published June 13, 2016; updated March 7, 2017)