What medications are used to treat rheumatoid arthritis (RA)?

The traditional treatment for RA includes non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). In recent years, the introduction of biologics has greatly expanded treatment options and improved outcomes.

1. NSAIDs help relieve pain and reduce fever but do not change the disease’s progression. Older NSAIDs can cause side effects such as stomach irritation or heart risks. Newer COX-2 selective NSAIDs may reduce stomach-related side effects.
2. Corticosteroids can effectively reduce joint inflammation. However, long-term use of high doses may lead to side effects like “moon face” or complications such as osteoporosis. Therefore, low doses are generally recommended.
3. DMARDs help regulate the immune system and slow down joint damage. These drugs are essential for long-term management. Regular blood tests are needed to monitor possible side effects (e.g., liver or kidney problems, or changes in blood counts). Common DMARDs include:

• Hydroxychloroquine – A mild medication with fewer side effects, often used for early or mild cases.
• Methotrexate (MTX) – The gold standard for RA treatment.
• Leflunomide – Suitable for patients who cannot tolerate MTX.
• Sulfasalazine – Often used for patients with gut issues or early RA.
• Cyclosporine – Used in severe cases or for patients with other autoimmune diseases.

4. Biologic agents and targeted synthetic drugs offer more precise control of inflammation and immune activity. These include:

Targeted oral medications (such as JAK inhibitors) are convenient and just as effective as biologics.

Insurance coverage in Taiwan:
Due to high costs, Taiwan’s National Health Insurance has strict rules for biologics and JAK inhibitors:

• Patients must first try at least two oral DMARDs (like MTX or Leflunomide) for over 6 months.
• After 6 months, blood tests must show active inflammation (high ESR or CRP levels) and many swollen/tender joints to apply for pre-approval.
• Treatment can start only after approval is granted.
• Ongoing approval is needed every 3 months, based on disease activity.

How is treatment effectiveness evaluated?

While many RA patients hope for full symptom relief, this can be difficult for those with long-term disease. Doctors aim to reduce disease activity, which greatly improves quality of life.

The DAS28 (Disease Activity Score based on 28 joints) is a common tool used to measure RA activity. It includes:

• The number of tender and swollen joints (out of 28)
• Inflammation marker (ESR) from blood test
• Patient’s self-rating of health on a 0–100 scale

DAS28 scores:

• Less than 2.6 = Remission (ideal goal)
• 2.6 to 3.2 = Low disease activity (a realistic goal for many)

Comparing DAS28 scores before and after treatment helps the doctor and patient decide whether to continue or adjust the treatment plan.

Daily Care Tips

Exercise and rest:

• Regular gentle exercise keeps joints flexible and helps with weight control.
• Swimming is a great low-impact option.
• Avoid high-impact activities when joints are inflamed.
• Good sleep and rest are also essential for joint recovery.

Hot and cold therapy:

• Use cold packs after exercise or during flare-ups to reduce pain.
• Use warm packs during calm periods to relax muscles.
• Not suitable for people with very sensitive skin or poor circulation.

Healthy diet:

• Like exercise, a balanced diet helps maintain a healthy weight and reduces joint stress.
• The Mediterranean diet (rich in fish, vegetables, and healthy fats) may reduce inflammation.
• Eat foods high in calcium and vitamin D to protect bones.
• Reduce intake of sugar and animal fats to lower the risk of obesity and heart disease.