What to Do If Your Rheumatoid Arthritis Treatment Isn’t Working

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Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that primarily affects the joints, and can also cause damage in other parts of the body. There is currently no cure for RA, but medication is often recommended as part of an overall treatment plan to help control symptoms. Fortunately, there are several different treatment options available if a medication isn't working as effectively as it should.

This article provides tips on how to manage your RA if it isn't responding to treatment, and explores some of the various RA treatment options available.

Hand and wrist pain in rheumatoid arthritis flare

Grace Cary / Moment / Getty Images

How to Tell If Your Treatment Isn't Working

The main goals of RA treatment are to reduce symptoms, like pain and inflammation, and maintain or improve joint mobility. If your current RA treatment plan is no longer helping you achieve those targets, it may need reconsidering.

Here are a few signs to watch for:

  • You experience more flares (periods when RA symptoms intensify) than usual, perhaps signaling that medications are losing effectiveness.
  • Your symptoms intensify or routinely prevent you from participating in your regular activities, like walking, working, exercising, or sleeping.
  • New symptoms arise, such as pain in a different joint, which could mean that inflammation is no longer under control.
  • You notice a change in symptoms, even a slight change like morning stiffness lasting longer than it usually does.

Your healthcare provider should also be observing you for signs that could indicate it's time to change treatment strategies. In addition to monitoring your symptoms and tracking your responses to medications, this can include ordering extra blood work, X-rays, and physical exams.

When to See a Healthcare Provider

New or worsening RA symptoms are a sign to call your healthcare provider. Keep an eye out for:

  • Sharp or constant pain
  • Change in symptoms
  • Increase in inflammation that doesn't get better with medication or rest
  • A sudden inability to participate in daily activities

Questions to Ask Your Healthcare Provider

Reevaluating your RA treatment plan with your healthcare provider may feel intimidating, but speaking up early is a good thing.

Your healthcare provider will want to hear directly from you as they assess your medical history. Be honest about your pain levels and treatment plan preferences, and ask questions about the process.

For example, you might consider asking:

  • Should we adjust the dosage of my current medication(s)?
  • What are my options for starting a new medication?
  • Are there any risks or side effects to switching medications?
  • How long will it take to see improvement on a new medication?
  • Do I need to make changes to other parts of my treatment plan, like my exercise routine?

Keep in mind that your healthcare provider will take into account several factors when writing your RA prescriptions, including your age, RA severity, and overall health. They may suggest changing your dosage, adding another medication to your routine, or switching medications altogether.

Is It Common to Change Treatments?

Occasional changes to an RA treatment plan are pretty normal. Treatment is not one size fits all, and medications can affect people differently. Keep in mind that it's usually recommended to give RA drugs a couple of months to take effect (unless there are severe side effects or another reason to stop treatment early). Most disease-modifying antirheumatic drugs (DMARDs) and biologics take three to six months to be fully effective. Always consult with a healthcare provider before making any treatment adjustments.

Rheumatoid Arthritis Medications

RA medications fall under the following five categories:

  • DMARDs are taken to cut down on inflammation and slow RA progression. Methotrexate (sold under the brand names Otrexup, Rasuvo, and Trexall) is usually the first treatment recommended for RA patients. Note that certain DMARDs may come with serious risks and side effects for some people.
  • Biologics are medications produced from living cells, meant to act like natural proteins of the body’s immune system. They are considered a second-line treatment, after DMARDs. They can improve inflammation and physical function, and may be prescribed in place of or in addition to a DMARD.
  • Corticosteroids like prednisone are sometimes prescribed for a shorter-period of time to help reduce inflammation and relieve pain, particularly while a DMARD starts working. While they're effective, corticosteroids have known side effects when used long term.
  • Pain relievers, whether they're available over the counter, like nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen sodium) and Tylenol (acetaminophen), or by prescription, may be used to treat pain and inflammation. Your healthcare provider will consider the risks and benefits of any narcotic pain relievers, as opioids have the potential to be addictive and prompt physical dependence.

There’s no way to predict how someone will respond to an RA treatment. Figuring out which medications are best for your individual situation often requires a trial and error approach. Expect to work closely with your healthcare provider during this process.

Other Steps You Can Take to Manage RA Symptoms

In addition to medication, there are several other pieces of an RA treatment plan that can help you manage your symptoms.

Some of these strategies include:

  • Regular exercise (as approved by your healthcare provider) is recommended for RA patients to maintain joint range of motion, improve flexibility, and support bone strength.
  • A healthy diet, particularly one that's high in antioxidants, is promising in combating inflammation.
  • Physical or occupational therapy sessions with an expert who specializes in arthritis can help guide movements for restoring joint function.
  • Home remedies, such as applying ice or heat, can calm inflammatory symptoms.
  • Mind-body therapies like meditation, yoga, deep breathing, massage, and tai chi may help decrease pain levels and improve mental health and well-being.
  • Stopping smoking is always recommended for RA patients, as this habit can contribute to the progression of RA by triggering inflammation and affecting blood circulation in the body.

Remember that home remedies and lifestyle adjustments aren’t meant to take the place of medications and supervised medical care. Always check with a healthcare provider before making any changes or adding to your current routine.

When to Consider Surgery

Severe cases of RA may require surgery to repair or replace a damaged joint, though it’s mostly considered a last resort.

Before recommending surgery, your healthcare provider may suggest trying minimally invasive procedures like laser therapy, which some studies have shown to be successful in improving pain and joint function for RA patients.

They’ll also look at your symptoms, treatment history, and X-ray results to ensure you’re a good candidate for surgery. This usually means:

  • Joint damage is extremely severe.
  • Joint pain is unbearable.
  • Medications no longer assist with painful symptoms.
  • You are at the age at which the joint prostheses will last the rest of your lifetime.
  • You are healthy enough to undergo anesthesia.

Summary

Rheumatoid arthritis (RA) is a chronic autoimmune condition that most noticeably causes pain, stiffness, and inflammation in the joints. Most RA patients use medications to help control symptoms, but sometimes a drug may no longer be as effective as it once was.

If you notice current symptoms getting worse or new symptoms appearing, it's time to talk to your healthcare provider about adjusting your RA treatment plan. In addition to other RA management techniques, like exercise and diet, several types of RA medications are available to help get you on the right track to feeling better again.

A Word From Verywell

It can feel frustrating and discouraging when your body isn't responding to the RA treatment plan that you've developed. But remember that it's possible to regain control over your symptoms and improve your quality of life. Your healthcare provider is there to help you find the most effective medications to achieve these goals.

For additional support from people who may be going through similar experiences, check out the Arthritis Foundation to get connected to a community network in your area.

Frequently Asked Questions

  • Why might some RA drugs stop working?

    Sometimes, the body no longer reacts to certain medications in the same way. This can especially happen with biologic drugs. Sometimes, the immune system sees the drug as an invader and develops antibodies to work against it, making the drug less effective or not effective at all. In other cases, a worsening condition could also be to blame for a medication no longer working as well as it once did.

  • How long does it take to see positive results from rheumatoid arthritis treatment?

    It can take several weeks or months to see the full effects from medications like DMARDs and biologics, which work on the body’s immune system and aren’t meant to provide immediate symptom relief. Other RA medications, like steroids and NSAIDs, start working quickly, within hours or days.

  • When should I consider changing rheumatoid arthritis treatment?

    If you notice worsening symptoms, new symptoms, or if you can't tolerate medication side effects, it's time to talk to your healthcare provider. They'll be able to walk you through multiple RA treatment options to find one that works for you.

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