Why Is Early Treatment for Rheumatoid Arthritis So Important?

Joint pain, swelling, and stiffness could all be potential symptoms of rheumatoid arthritis, an inflammatory autoimmune condition. If you’re experiencing such symptoms for several weeks without improvement, do not delay evaluation and treatment by a specialist.

Why is it so critical to diagnose and treat RA early? "There is a progression of damage to joints that is irreversible,” says Timothy Niewold, MD, the vice chair for research in the department of medicine at the Hospital for Special Surgery in New York City. “Your body tries to heal it, but it’s really never the same. A number of studies have shown that sometimes even when someone is first diagnosed with RA, you can already see some of these changes on X-rays and MRIs. That tells us that we have to think of treatment right away.”

Early treatment that reduces disease activity can prevent further damage.

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In 2016, the European League Against Rheumatism (EULAR) updated its recommendations for early referral to a rheumatologist: Patients should seek help within six weeks of symptom onset, and early management should be directed by a rheumatologist. The recommendations also suggest patients at risk for chronic arthritis should begin a course of disease-modifying antirheumatic drugs (DMARDs) within three months after symptoms appear.

Early and aggressive RA treatment is recommended by all the scientific and medical societies all over the world, stresses Cristiano Zerbini, MD, a rheumatologist and the director of the Centro Paulista de Investigação Clinica in São Paulo, Brazil, whose research team found in results published in Osteoporosis International that “treatment with biologic drugs is associated with the decrease in bone loss. Studies with anti-TNF blocking agents show preservation or increase in spine and hip BMD [bone mineral density] and also a better profile of bone markers.”

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Zerbini explains that early treatment that stops disease activity also stops joint and bone destruction. "You may compare the inflammatory process in the beginning of the disease to a bonfire that may become a [larger] fire, destroying the joint and adjacent bone if [it's] not eliminated by treatment as soon as possible,” he says. The bottom line: Do not delay treatment.

Zerbini adds, “The active disease leads to a continuous loss of bone and consequently to osteoporosis, leaving the patient with a high probability of a low-trauma fracture. The pain and deformity prevent the ability to exercise, which contributes to additional loss of bone.”

Be sure to see a rheumatologist if you have swelling, redness, and stiffness in the small joints of your hands, feet, wrists, and ankles. This tends to be symmetrical (the same on both sides), though this is not always the case early on, notes the Johns Hopkins Arthritis Center. “It’s not a perfect symmetry,” says Niewold, “but usually you will get symptoms in both hands or both feet.” Feeling very stiff in the morning is another symptom.

A rheumatologist may use the following to diagnose you:

• A physical exam of your joints
• Blood tests, which will show if there is inflammation in the body
• X-rays, MRIs, or other imaging tests, to see how severely the joints are affected

The first-line treatment for RA is usually a DMARD called methotrexate (Rheumatrex, Trexall). You may also get steroids or corticosteroids as an anti-inflammatory. Some people may need to increase the methotrexate dose. “That brings us to the next decision point: Is the methotrexate enough? If it’s not enough, you might need to add another medication, such as TNF-blocking drugs, which are also anti-inflammatories,” says Niewold.

While swift action and aggressive treatment may make perfect sense to the experts, starting meds immediately can feel like a whirlwind for people newly diagnosed with RA. Patients can be resistant to taking medication because they don’t want to be “on” something their entire lives. But Niewold points out that a drug regimen isn’t always lifelong; it depends on the disease's progression. “There is always risk in treatment, but there is also a large risk in not treating,” he says.

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“The general paradigm is if you don’t treat RA, it goes badly. You will have long-term disability, losing joint function and mobility,” explains Niewold. “It’s also probably better for your cardiovascular system, as there is early atherosclerosis and cardiovascular morbidity in RA. Most of the studies are supporting the idea that early intervention and active treatment helps prevent that downstream complication.”

Take the following steps to improve your health with RA if you haven't already.

• Stop smoking. Studies have shown that smoking increases your risk for RA. And if you continue to smoke while taking certain RA meds, they may not work as well, according to research.
• Engage in low-impact exercise. Exercise can help improve RA symptoms. You may just need to modify it a bit. Yoga is good because in involves both moving and stretching.
• Try to lose weight. Shedding extra pounds will mean less strain on your joints in general.
• Change your diet. Many people with RA say that following an anti-inflammatory diet has helped with their symptoms. The Mediterranean diet is also recommended for people with RA.
• Work with your rheumatologist to find the right treatment plan for you. If you aren’t feeling relief from your course of disease management, don’t give up, says Niewold. “There are lots and lots of tools in the toolbox now.”