From the Guidelines
The treatment for rheumatoid arthritis should start with disease-modifying antirheumatic drugs (DMARDs) like methotrexate, with the goal of achieving remission or low disease activity, as recommended by the 2021 American College of Rheumatology guideline 1.
Treatment Approach
The approach to treating rheumatoid arthritis involves a combination of medications, lifestyle modifications, and sometimes surgery.
- Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate are the cornerstone of treatment, often initiated soon after diagnosis to prevent joint damage.
- Biologic agents like TNF inhibitors (adalimumab, etanercept), IL-6 inhibitors (tocilizumab), or JAK inhibitors (tofacitinib) may be added for patients who don't respond adequately to conventional DMARDs.
- For symptom management, NSAIDs like ibuprofen or naproxen can help with pain and inflammation, while low-dose corticosteroids like prednisone may be used temporarily during flares.
Lifestyle Modifications
Regular physical therapy, maintaining a healthy weight, and gentle exercise help preserve joint function.
- Heat and cold therapy can provide pain relief, and assistive devices may help with daily activities.
- These treatments work by targeting the immune system's inflammatory response that causes joint damage, with the goal of achieving remission or low disease activity while minimizing medication side effects and improving quality of life, as supported by the EULAR recommendations 1.
Monitoring and Adjustment
Monitoring should be frequent in active disease, with therapy adjusted if there is no improvement by at most 3 months after the start of treatment or the target has not been reached by 6 months, as recommended by the EULAR guidelines 1.
- Treatment decisions should follow a shared decision-making process, taking into account factors such as disease activity, progression of structural damage, comorbidities, and safety issues, as emphasized by the 2021 American College of Rheumatology guideline 1.
From the FDA Drug Label
- 1 Rheumatoid Arthritis Enbrel is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis (RA). Enbrel can be initiated in combination with methotrexate (MTX) or used alone.
The treatment for Rheumatoid Arthritis is Enbrel (etanercept), which can be used alone or in combination with methotrexate (MTX) to reduce signs and symptoms, induce major clinical response, inhibit the progression of structural damage, and improve physical function in patients with moderately to severely active Rheumatoid Arthritis (RA) 2.
- Key points:
- Enbrel (etanercept) is indicated for the treatment of Rheumatoid Arthritis (RA)
- Can be used alone or in combination with methotrexate (MTX)
- Reduces signs and symptoms, induces major clinical response, inhibits the progression of structural damage, and improves physical function in patients with moderately to severely active RA
From the Research
Treatment Options for Rheumatoid Arthritis
The treatment for Rheumatoid Arthritis (RA) includes various pharmacologic options, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation 3
- Disease-modifying antirheumatic drugs (DMARDs) as first-line therapy for newly diagnosed cases of RA, including methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide 3, 4
- Biological-response modifiers, such as infliximab, etanercept, and adalimumab, which selectively inhibit specific molecules of the immune system 3
- Glucocorticoids to control pain, inflammation, and stiffness related to RA 3
Combination Therapy
Combination therapy, which involves the use of two or more DMARDs, has been shown to be effective in achieving better efficacy than monotherapy without increasing drug side effects 5, 6. Examples of combination therapy include:
- Methotrexate, sulfasalazine, and hydroxychloroquine 5, 6, 7
- Methotrexate and cyclosporine 5
- Methotrexate and biologic DMARDs, such as etanercept, infliximab, and anakinra 5, 7
Benefits of Early Aggressive Therapy
Early aggressive therapy with a combination of drugs or biological agents may be warranted for the effective treatment of RA, as it has been shown to slow clinical and radiographic progression of the disease 3, 6, 7. This approach has been demonstrated to be beneficial in clinical trials, with improved outcomes in terms of disease activity and joint damage 7.