What is the treatment for the root cause of Rheumatoid Arthritis (RA)?

From the Guidelines

The most effective treatment for the root cause of Rheumatoid Arthritis (RA) is to start aggressive treatment early with disease-modifying antirheumatic drugs (DMARDs), with the goal of achieving remission or low disease activity, as recommended by the 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1.

Treatment Approach

The treatment approach should involve a shared decision-making process, with treatment decisions reevaluated within a minimum of 3 months based on efficacy and tolerability of the DMARD(s) chosen 1.

• Conventional DMARDs (csDMARDs) such as methotrexate, leflunomide, and sulfasalazine are recommended as the initial treatment, with methotrexate being the preferred choice due to its efficacy and safety profile 1.
• Biologic DMARDs (bDMARDs) such as tumor necrosis factor (TNF) inhibitors, interleukin-6 (IL-6) receptor inhibitors, and T cell costimulatory inhibitors may be added if the patient does not respond to csDMARDs or has a contraindication to them 1.
• Targeted synthetic DMARDs (tsDMARDs) such as Janus kinase (JAK) inhibitors may also be considered as an alternative to bDMARDs 1.

Lifestyle Modifications

In addition to pharmacological treatment, lifestyle modifications such as regular low-impact exercise, maintaining a healthy weight, and quitting smoking can help reduce inflammation and slow disease progression 1.

Monitoring and Adjustment

Regular monitoring of disease activity using validated instruments and modification of treatment to minimize disease activity with the goal of reaching a predefined target (low disease activity or remission) is crucial for long-term management 1.

• Treatment should be 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 1.
• The goal is to achieve remission or low disease activity, effectively addressing the root cause as much as current medical science allows 1.

From the FDA Drug Label

B cells are believed to play a role in the pathogenesis of rheumatoid arthritis (RA) and associated chronic synovitis. In this setting, B cells may be acting at multiple sites in the autoimmune/inflammatory process, including through production of rheumatoid factor (RF) and other autoantibodies, antigen presentation, T-cell activation, and/or proinflammatory cytokine production.

The treatment for the root cause of Rheumatoid Arthritis (RA) is not directly addressed in the provided drug label, as it only describes the mechanism of action of rituximab in depleting B cells, which are believed to play a role in the pathogenesis of RA.

• Main Idea: The root cause of RA is not explicitly stated in the label.
• Key Point: Rituximab targets B cells, which are involved in the autoimmune/inflammatory process of RA. However, the label does not provide information on the treatment of the underlying cause of RA, only the treatment of its symptoms through B-cell depletion. 2

From the Research

Treatment for Rheumatoid Arthritis (RA)

The treatment for Rheumatoid Arthritis (RA) focuses on reducing pain and inflammation, as well as preventing further joint damage.

• Current treatment options include disease-modifying anti-rheumatic drugs (DMARDs), such as conventional synthetic, biologic, and targeted synthetic drugs 3.
• Other treatment options include TNF-α blockade, B cell therapy, IL-1 and IL-6 blockade, and angiogenesis inhibition 4.
• Synthetic drugs, such as cyclophosphamide, sulfasalazine, methotrexate, nonsteroidal anti-inflammatory drugs (NSAIDs), and intramuscular gold, are also available for the treatment of RA 4.

Limitations of Current Treatment Options

• Despite the availability of various treatment options, there is currently no cure for RA 5, 3, 6.
• The lack of understanding of the basic mechanisms that initiate and sustain the disease remains a major obstacle in the search for a definitive cure 5.
• Current treatment options may have adverse effects, such as hepatorenal effects, hypertension, and gastric ulcers 4.

Future Directions

• Research is needed to identify individuals at risk and devise reliable, safe methods of preventing the disease before it occurs 5.
• Precision prevention strategies, which involve identifying individuals at high risk for RA and providing them with advice on how to change lifestyle/environment or giving them treatment with drugs able to delay and ultimately stop the development of RA, may be a promising approach 7.
• Further research is needed to develop more effective and safe treatment options, as well as to improve our understanding of the pathophysiological mechanisms underlying RA 3, 4, 7.