Rheumatoid Arthritis Treatments: What Works Now and What to Expect Next
Why Rheumatoid Arthritis Treatments look different today
Rheumatoid arthritis (RA) is far more manageable than it used to be. With early diagnosis, a treat-to-target plan, and modern medicines, many people reach low disease activity or remission and keep joint damage from progressing. Below is a plain-language, up-to-date roadmap to the options your rheumatology team may recommend—and how they’re sequenced safely.
The treatment game plan (treat-to-target RA)
Your rheumatologist will set a clear target—remission or low disease activity—and adjust therapy every 1–3 months until you get there. Regular assessments such as joint counts, blood tests, and patient-reported scores guide each step. This strategy improves outcomes and helps you avoid staying on partly effective therapy for too long.
First-line foundation: conventional (non-biologic) DMARDs
- Methotrexate is the anchor drug for most adults with active RA unless contraindicated.
- If methotrexate alone isn’t enough, your clinician may:
- Adjust the dose or split dosing
- Add folate to reduce side effects
- Combine methotrexate with hydroxychloroquine, sulfasalazine, or leflunomide
- Adjust the dose or split dosing
- Long-term steroids are generally avoided. If needed, they are kept short and low-dose while DMARDs take effect.
If RA remains active: biologics and targeted therapies
When disease persists despite optimized methotrexate, your doctor may recommend:
TNF inhibitors
(adalimumab, etanercept, infliximab, certolizumab, golimumab)
Non-TNF biologics
(abatacept, rituximab, tocilizumab, sarilumab)
JAK inhibitors
(tofacitinib, baricitinib, upadacitinib)
The choice depends on your health history, infection risks, heart status, pregnancy plans, and how well you’ve responded to past therapies. Biologics are often combined with methotrexate unless there’s a reason not to.
Important safety update: JAK inhibitors carry FDA boxed warnings about possible risks of blood clots, cancer, heart-related events, and death. They are often used when other biologics are not suitable or have failed. Shared decision-making is essential.
Rheumatology Center of Delaware's Rheumatoid Arthritis Services in Delaware
Rheumatoid Arthritis
Crohn’s
Osteoarthritis
Psoriasis and
Psoriatic Arthritis
Systemic Lupus
Ulcerative colitis
Joint injections
Connective
tissue disease
Osteoporosis
Temporal arteritis
Vasculitis
Generalized
joint pain
Ankylosing Spondylitis
Gout
Fibromyalgia
Polymyalgia
rheumatica
Biosimilars can expand access
Many biosimilars for adalimumab are now FDA-approved, with some listed as interchangeable. This means they can be substituted for the brand product in certain settings, making treatments more accessible and affordable. Ask your care team or pharmacist about biosimilars that may fit your plan.
RA Treatments Simplified
DMARDs (methotrexate, hydroxychloroquine, sulfasalazine, leflunomide): first choice, need labs, folate with methotrexate.
TNF Inhibitors (adalimumab, etanercept, infliximab): if DMARDs fail; screen TB/hepatitis.
Non-TNF Biologics (abatacept, rituximab, tocilizumab, sarilumab): after TNF blockers; watch infections.
JAK Inhibitors (tofacitinib, baricitinib, upadacitinib): oral option; higher risk, boxed warnings.
Essentials
Stay up to date on vaccines.
Exercise, manage weight, quit smoking.
NSAIDs/steroids only for short flares.
Care Plan
Frequent visits early, then less often.
Stepwise med changes until goals met.
Possible taper in remission.
FAQs
When will I feel better? DMARDs: 6–12 weeks; biologics/JAKs may be faster.
Are JAKs safe? Effective, but reserved due to risks.
Can I switch to biosimilars? Often yes, depending on state/insurance.
Bottom Line
The best approach to rheumatoid arthritis starts with conventional DMARDs as the foundation of care. If symptoms remain uncontrolled, treatment is escalated step by step to biologics or JAK inhibitors. Alongside medications, healthy lifestyle choices—such as exercise, weight management, and quitting smoking—plus staying up to date on vaccines, play a key role in protecting long-term health. Ongoing monitoring with your rheumatologist ensures treatments are adjusted as needed, helping you reach remission and maintain the best quality of life possible.
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