Topical Treatments for Joint Pain in RA

Treating rheumatoid arthritis (RA) typically means taking drugs to address the inflammatory process that leads to joint pain in RA. These drugs may be taken by mouth, or by injection or infusion.

But in some cases, using a topical treatment — applied to the skin surface — may help reduce some forms of joint pain. Here’s what you should know about the possible benefits and risks of topical treatments in RA, and when to talk with your doctor before using them.

Topical treatments aren’t widely considered to be a first-line treatment for joint pain caused by rheumatoid arthritis. But they may be a good choice when it’s likely that your joint pain isn’t directly caused by RA.

Even in people with diagnosed RA, “The particular ache or pain they’re feeling may not be due to rheumatoid arthritis. They may have osteoarthritis, or they may have a mechanical process like tendonitis,” says Kevin Deane, MD, a rheumatologist at University of Colorado Health in Aurora.

You may benefit from topical creams or ointments when it’s clear, or you suspect, that your joint pain is due to an overuse injury or is aggravated by certain activities, Dr. Deane says. But it’s also important to rule out an RA flare as a cause of your pain. In that case, he says, you may need to change or intensify your RA treatment.

If you use topical treatments for an RA flare, “What we’re concerned about is you might feel better, but the fundamental inflammation and damage to the joint won’t be directly affected.” says Deane. But if you’re getting effective treatment for RA during a flare, topical treatments can be used as an adjunct therapy for shorter periods of time, he says.

In some cases, a topical treatment not being effective can be evidence that your joint pain is due to an RA flare rather than something like an overuse injury. “It will only treat the top surface of the joint, which is not sufficient and will not give relief” in most cases of true RA joint pain, says Talia Torkian, a rheumatology physician assistant at Mount Sinai in New York City.

A number of different topical creams, ointments, and patches may be used to treat joint pain in people with rheumatoid arthritis. Here are some of the most common treatment types.

Topical NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

When it comes to topical treatments, “The best studies are on the topical nonsteroidals, like diclofenac. It has pretty substantial safety data,” says Deane. That means for most people, it’s safe to apply diclofenac as directed to the area of your joint pain up to four times a day.

Diclofenac is available over the counter, but if you use it multiple times daily, getting a prescription version of it that your insurance covers may end up saving you money, Deane says.

Topical NSAIDs like diclofenac tend to work best when your joint pain is mild to moderate and not widespread.

“When patients have pain in one or two joints, they can use topical Voltaren gel for some relief, although it won’t be as helpful as systemic treatment,” says Torkian, who notes that this treatment is often useful for people with both RA and osteoarthritis.

Capsaicin

Capsaicin is a treatment derived from chili peppers, and it works by blocking a chemical in nerve cells that sends pain signals. It typically causes a burning sensation when applied to your skin, and may be particularly effective for osteoarthritis in your knees or hands.

Capsaicin-based treatments can take a bit longer to work than topical NSAIDs.

“They may take days to alter the nerves’ processing of pain, but they can be quite effective,” says Deane, who notes that they can be good for pain in elbows as well as knees or hands.

It’s important to wash your hands thoroughly after applying capsaicin creams, since they can cause a burning sensation in your ears, mouth, nose, or eyes.

Lidocaine

“Lidocaine basically blunts pain. It doesn’t alter inflammatory pathways, and it often won’t work for a long period of time, because the body becomes accustomed to it,” says Deane.

For this reason, he says, it’s best for temporary conditions like overuse injuries or recovery from procedures like knee arthroscopy.

Salicylates

Counterirritants

Topical treatments for joint pain are typically safe to use in the context of rheumatoid arthritis. Still, it’s a good idea to follow some precautions:

• Read the instructions. Don’t apply a treatment to areas of the body where it’s not recommended, and don’t use it more often than the instructions say you should.
• Test a small area. Especially if you have sensitive skin, apply a small amount of any cream or gel to see if you have an adverse reaction before attempting a full treatment.
• Avoid broken or irritated skin. Only apply topical treatments to healthy, unbroken areas of skin.
• Wash your hands. Make sure your hands are clean before applying topical treatments, and wash your hands afterwards — especially if the treatment contains a potential irritant like capsaicin.
• Use heat with caution. Applying heat to an area where certain topical treatments have been applied can cause skin irritation.
• Talk to your doctor. Make sure any topical treatment is compatible with your main RA treatments, and that your RA is being treated effectively aside from topical treatments. “Topicals probably aren’t a good long-term option for primary treatment of RA,” says Deane.

• Topical treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and capsaicin, may provide relief for joint pain in rheumatoid arthritis (RA) that isn't directly caused by RA inflammation.
• These treatments should be applied according to instructions to reduce the risk of skin irritation and should be discussed with a healthcare provider to avoid potential drug interactions.
• It's important to identify whether your pain is from an RA flare or another issue; topical treatments like NSAIDs are best for specific, mild episodes of pain, rather than long-term RA management.
• If symptoms persist or worsen, consult a healthcare professional, as untreated RA inflammation can cause continued joint damage even if pain is momentarily relieved.