Rheumatoid Arthritis Treatment: Medication, Lifestyle Changes, and More

Rheumatoid Arthritis Treatment: Medication, Lifestyle Changes, and More

Rheumatoid Arthritis Treatment: Medication, Lifestyle Changes, and More
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Updated on September 19, 2025
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There is no known cure for rheumatoid arthritis (RA), but treatment can help you manage the condition, which affects about 1.5 million adults in the United States.

 Treatment focuses on effectively stopping the progression of the disease through:
  • Reducing RA symptoms, such as pain and joint swelling, and long-term complications, such as joint deformities
  • Getting joint inflammation under tight control or stopping it altogether (putting the disease in remission)
  • Minimizing joint and organ damage
  • Improving physical function and quality of life

Achieving RA remission is a lot easier for people who don't have high disease activity — that is, people who don't have inflammation that affects numerous joints, evidence of bone erosion, rheumatoid nodules, or blood that's positive for certain inflammation-related antibodies, among other things.

Medications, physical therapy, and surgery are proven therapies for rheumatoid arthritis.

Medication

Early, aggressive treatment of RA can help control symptoms and complications before the disease significantly worsens, by reducing or altogether stopping inflammation as quickly as possible. It's key to preventing disability.

This strategy essentially amounts to treatment with disease-modifying antirheumatic drugs (DMARDs), including biologic DMARDs and targeted synthetic DMARDs called JAK inhibitors, sometimes more than one at a time, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids if needed to help reduce pain and swelling.

As their name implies, DMARDs can slow the progression of RA. Corticosteroids and NSAIDs, on the other hand, can help with acute pain and inflammation but do not stop or slow the progression of RA, though corticosteroids, such as prednisone and prednisolone, may help preserve function until DMARDs can start taking effect.

Disease-Modifying Antirheumatic Drugs (DMARDs) for RA

Doctors usually prescribe DMARDs very early in the course of the RA disease, sometimes right after a diagnosis is made. The goal is to prevent cartilage damage and bony erosions, which can develop within the first two years of the disease.

 Each of these drugs works differently, but all ultimately alter or slow the course of RA by suppressing the body's overactive immune system or inflammatory processes.

“The first medication prescribed is methotrexate or another disease-modifying antirheumatic drug (DMARD) to slow the progression of the disease and reduce inflammation,” says Kristin Ingraham, MD, chief of the division of rheumatology at Lehigh Valley Health Network in Allentown, Pennsylvania.

In its most recent guideline for the treatment of RA, the American College of Rheumatology (ACR) recommends maximizing the use of Methotrexate (Trexall). This is because the drug has a long history of use and a lot of research documenting its effectiveness.

Still, as many as 20 to 50 percent of people taking methotrexate don’t respond to the medication, and it does have potential side effects (upset stomach, thinning hair, and mouth sores).

“Certain patients should not take methotrexate, particularly those who are pregnant or breastfeeding,” says Dr. Ingraham.

If methotrexate alone ultimately proves insufficient to control RA symptoms, the ACR recommends pairing it with other DMARDs.

All DMARDs, including biologics, can become less effective over time and may even stop working, usually because the immune system starts to recognize the medicine as foreign (and subsequently attacks it). Often, doctors prescribe a combination of two or three DMARDs, which makes treatment more effective and the body less likely to form antibodies against the drugs.

Biologics

A class of DMARDs called biologics works by targeting the inflammatory process. Biologics are created from living cells and other materials. They are usually used to treat moderate to severe RA, and prescribed to patients who have not responded well to conventional DMARDs or other treatments.

“Biologics work to interfere with different targets in our immune system such as tumor necrosis factor (TNF) and interleukin-6 (IL-6), among others,” Ingraham explains.

The first conventional biologics that became available work to inhibit tumor necrosis factor (TNF) alpha, a pro-inflammatory substance in the immune system. Anti-TNF drugs, or TNF inhibitors, include:

  • etanercept (Enbrel)
  • adalimumab (Humira)
  • certolizumab (Cimzia)
  • golimumab (Simponi, Simponi Aria)
  • infliximab (Remicade)
Biosimilars are also available as a substitute for some anti-TNF biologics and are typically less expensive.

 Biosimilars include:
  • infliximab (Avsola, Inflectra, Renflexis)
  • adalimumab (Amjevita)
Other biologics are also available for treatment of RA, including:

  • B-cell Inhibitors such as rituximab (Rituxan) and rituximab biosimilars (Riabni, Ruxience, and Truxima), which are often used when TNF drugs and methotrexate are not effective.
  • Interleukin inhibitors block inflammatory proteins. Several forms of this medication are available including: anakinra (Kineret), canakinumab (Ilaris), guselkumab (Tremfya), ixekizumab (Taltz), risankizumab (Skyrizi), sarilumab (Kevzara), secukinumab (Cosentyx), tocilizumab (Actemra), and ustekinumab (Stelara).
  • Selective costimulation modulators help to block overactive T-cells. The only form approved for RA is abatacept (Orencia).

Biologics can increase your risk of developing serious infections and certain cancers.

You should discuss the risks and the benefits with your doctor before making a switch to biologics to help you make a decision about your treatment.

JAK Inhibitors

JAK inhibitors are for difficult-to-treat RA, and they work by blocking another part of the body's immune response: Janus kinase (JAK) pathways.

Unlike biologics, which are either injected or given as an IV infusion, JAK inhibitors are taken orally.

JAK inhibitors include:

  • tofacitinib (Xeljanz, Jakvinus)
  • baricitinib (Olumiant)
  • upadacitinib (Rinvoq)
In 2021, the FDA announced that JAK inhibitors should be used to treat RA only in people who didn’t respond to or could not tolerate one or more TNF blockers. In addition, the agency stressed that JAK inhibitors can increase the risk of serious heart-related events like heart attack or stroke, as well as the risk of cancer, blood clots, and death, especially for past or current smokers and those with existing heart conditions.

Other Medications

Conventional and biologic DMARDs are not designed to treat pain, and they can take several weeks to become effective at reducing inflammation.

Your doctor may prescribe corticosteroids and NSAIDs in the meantime to help with acute pain and inflammation. Your doctor may also prescribe corticosteroids while waiting for your DMARD to start working.

But the ACR recommends prescribing corticosteroids as infrequently as possible and at the lowest effective dose, due to the drugs' risks, including infection, weight gain, bone fractures, and osteoporosis.

Surgery

For many people, medication and other therapies are enough to keep RA under control. But if you experience severe joint damage that limits your ability to carry out daily functions, surgery may be an option for you.

Surgery is not a cure for RA and is not a treatment for remission. Joint surgery is only conducted after careful consideration, and can help reduce pain, improve joint function, and improve your quality of life.

A surgeon may operate to:

  • Clean out inflammation-causing bone and cartilage fragments from the joint, fix tears in soft tissues around joints, or repair damaged cartilage and ligaments (arthroscopy)
  • Remove some or all of the inflamed joint lining (synovectomy)
  • Fuse a joint (arthrodesis) so that it no longer bends and is properly aligned and stabilized
  • Replace a joint (arthroplasty), particularly of the ankles, shoulders, wrists, and elbows, with an artificial one made of plastic, ceramic, or metal
  • Cut and remove bone or add a wedge of bone near a damaged joint, to shift weight from a damaged area to an undamaged one (osteotomy)

In 2025, the FDA approved a device that uses vagus nerve stimulation for the treatment of RA.

 This implanted device helps to stimulate anti-inflammatory and immunomodulatory properties in your body. It works by providing an electric stimulation to the vagus nerve, which carries signals between your brain, heart, and digestive system, and runs from your brain to your large intestine.

A surgeon needs to implant the device in your neck. The device provides some electrical stimulation for a short duration each day in order to help regulate your body’s immune response, reducing inflammation associated with RA.

Ingraham, of the Lehigh Valley Health Network, participated in the research study that led to the FDA approval of the implantable device , and says she’s comfortable discussing this option with her patients who are interested in exploring this novel therapy.

Lifestyle Changes

Lifestyle modifications are not a substitute for medical treatment. But as part of an overall treatment plan, making certain changes may help you manage the condition.

Dietary Changes

When it comes to the connection between diet and rheumatoid arthritis improvement, much of the scientific evidence is inconclusive. And it's important to check with your doctor before you make any significant changes to your dietary habits.

Still, certain dietary modifications are touted to help relieve RA symptoms, especially those that reduce inflammation.

Research suggests that following an anti-inflammatory Mediterranean diet — high in fiber and rich in omega-3 fatty acids from seafood and healthy fats from olive oil — may help control RA symptoms.

 Further studies have shown that a higher adherence to the diet is also associated with a lower risk of developing RA in the first place.

Fish oil — high in anti-inflammatory omega-3 fatty acids — has been shown to be helpful in reducing joint swelling and pain. According to a review of studies, omega-3 supplements help to reduce the number of affected, tender joints in people with RA.

Research suggests that vegetarian or vegan diets may help people with RA, but responses to it are highly individualized. Fasting, sometimes followed by a vegetarian or vegan diet, can produce significant but temporary improvement in subjective symptoms, such as morning stiffness.

 Vitamin D supplementation and reduced sodium intake has also been found to help reduce symptoms.

Some people report a beneficial effect from excluding certain food groups from their diet, such as going gluten-free or lactose-free. Lately, the ketogenic (keto) diet — a high-fat, very low-carb diet — has gained popularity, and while it may help you lose weight, it's not recommended for those with RA because it's high in fats that promote inflammation and it is low in grains, fruit, and many vegetables that help reduce inflammation. Consider working with a nutritionist if you’re exploring food elimination and always review major dietary changes with your healthcare team first.

Other Lifestyle Changes

In addition to dietary changes, some other modifications to your routines may help. The Arthritis Foundation recommends:

  • Regular exercise or movement
  • Stopping or never smoking
  • Communicating with your partner about challenges
  • Seeking mental health help as needed
  • Talking to an occupational therapist (OT) about assistive devices and making workplace and home accommodations

When it comes to exercise, Ingraham recommends “both cardiovascular and weight training exercises to maintain health and improve strength and balance.” And she stresses the importance of generally being active and engaged with “social activities with friends, family, work, and/or volunteering.”

Rehabilitation and Therapy

Your doctor may prescribe physical therapy and occupational therapy along with medication to help relieve pain and joint stress. Though you can start any time, experts recommend making an appointment with an occupational therapist shortly after diagnosis to help maximize your benefits.

Occupational Therapy

An OT can teach you how to modify your home and workplace and better navigate your surroundings to effectively reduce strain on your joints and prevent further aggravation of the inflammation during your day-to-day activities. Additionally, they can teach you how to perform regular tasks in different ways to better protect your joints.

OTs may also provide splints or braces that help support weakened and painful joints, and recommend devices to help you with daily tasks, such as bathing. They can help improve your ability to work or participate in recreational activities, paying special attention to maintaining the function of your hands and arms.

Physical Therapy

A physical therapist (PT) can show you exercises to strengthen your muscles and keep your joints movable and flexible. Range-of-motion exercises, strengthening exercises, and low-impact endurance exercises (walking, swimming, and cycling) all can help you preserve the function of your affected joints.

They'll teach you joint protection techniques, such as how to maintain proper body position and posture, body mechanics for specific daily functions, and how to distribute pressure to minimize stress on individual joints.

A PT may use hot or cold packs to temporarily reduce pain and stiffness in your joints. They may recommend a podiatrist (foot specialist) to help you find supportive footwear and use orthotics, or devices that keep your feet in the correct positions.

Occupational and physical therapists can also teach you about the hand exercises that are best for you, in order to improve grip strength and finger range of motion, and decrease stiffness for RA patients.

Complementary and Integrative Approaches

Complementary therapies that fall outside of conventional Western medicine may provide additional relief.

You might want to explore therapies such as acupuncture, tai chi, and yoga. While some people have found these approaches helpful, the research overall hasn't found clear, definitive benefits. Homeopathy, hydrotherapy, or cryotherapy, might also help relieve RA symptoms, though the clinical evidence supporting these methods has been inconclusive.

You should always check with your medical provider before trying any complementary therapies.

You'll also want to check with your doctor before using home remedies to relieve the pain and inflammation from a flare-up. At-home treatments that may help soothe pain and stiffness include hot or cold treatments, over-the-counter topical pain relievers, and braces or splints that support the joints.

Pain Management

Treating pain and discomfort related to RA won't stop the progression of disease, but it can help you live more comfortably.

While DMARDs slow disease progression and reduce inflammation, they're not used to treat acute pain. Instead, doctors typically recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve) and prescription dolobid (Diflunisal), and, for a brief duration, corticosteroids, such as prednisone and prednisolone.

Exercise for RA Pain Management

RA pain can lead to a frustrating cycle: the pain causes people to become less active, but diminished physical fitness can then worsen symptoms. Inactivity can result in contractions and loss of joint motion and muscle strength.

Exercise has several potential benefits including:

  • Lessening the pain, stiffness, and disability
  • Boosting strength and flexibility providing both support and better function in the joints
  • Improving mental health
  • Helping reduce the risk of cardiovascular disease and diabetes

An experienced physical or occupational therapist can create an exercise plan to help you relieve RA symptoms. An exercise regimen for RA will likely be a mix of low-impact aerobic exercises and those that target flexibility, strengthening, and body awareness.

Mental Health Treatment

Living with RA increases your risk of developing mental health conditions, most commonly anxiety and depression. Conversely, living with depression or anxiety can worsen your RA symptoms.

It's important to pay attention to your mental health and to take steps to reduce the stress of living with RA. Relaxation techniques, visualization exercises, group counseling, and psychotherapy are worth considering.

The Takeaway

  • RA treatments focus on slowing the progression of the disease and providing symptom relief.
  • Medications that target the immune system’s response are typically first-line treatment and some include targeted therapy. Surgery can provide relief from pain and improve function in some cases.
  • In addition to medical treatments, you can take several steps to manage symptoms, including potential changes to diet, exercise, quitting smoking, and managing your mental health.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  7. Rath L. Biologics. Arthritis Foundation. September 2022.
  8. Biosimilars: What You Should Know. Arthritis Foundation.
  9. About Orencia. Orencia.com.
  10. Rheumatoid Arthritis and Cancer Risk. Arthritis Foundation. May 21, 2020.
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  12. FDA Requires Warnings About Increased Risk of Serious Heart-Related Events, Cancer, Blood Clots, and Death for JAK Inhibitors That Treat Certain Chronic Inflammatory Conditions. U.S. Food and Drug Administration. September 21, 2021.
  13. Understand Your Joint Surgery Options. Arthritis Foundation.
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  15. Vagus Nerve. Cleveland Clinic. January 1, 2022.
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  17. Hu P, et al. Mediterranean Diet and Rheumatoid Arthritis: A Nine-Year Cohort Study and Systematic Review with Meta-Analysis. European Journal of Clinical Nutrition. May 2025.
  18. Wang W, et al. Effects of Omega-3 Supplementation on Lipid Metabolism, Inflammation, and Disease Activity in Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials. Clinical Rheumatology. August 2024.
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Meet Our Experts
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Beth Biggee, MD

Medical Reviewer
Member of American College of Lifestyle Medicine, Castle Connolly Top Doctor

Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.

Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.

Dr. Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.

In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed "introduction to clinical medicine" for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.

Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.

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Jenna Fletcher

Jenna Fletcher

Author

Jenna is a health and wellness writer with more than 12 years of experience writing in the consumer health field across many publications. Prior to health writing, she spent years working as certified personal trainer and fitness instructor with certifications across multiple specialties.

Currently, her interest primarily lies in writing about women's health and wellness topics, mental health care, and more. She enjoys taking complex topics and breaking them down into easy to understand pieces of information.

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