Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid a chronic autoimmune disease where the body’s own immune system attacks the joints. This results in joint inflammation, which manifests as joint swelling.

It is important to treat rheumatoid arthritis early. Leaving rheumatoid arthritis untreated can lead to irreversible joint damage. Chronic inflammation also increases the risk of cancer, heart attacks, bone thinning (osteoporosis) and early death. The longer rheumatoid arthritis is left untreated, the harder it can be to achieve remission.

RheumInfo: Rheumatoid Arthritis: https://rheuminfo.com/en/diseases/rheumatoid-arthritis/

Patient Journey: Rheumatoid Arthritis: https://arthritis.ca/treatment/your-patient-journey/rheumatoid-arthritis-en

Inflammatory Arthritis Self-Management: https://arthritis.ca/treatment/self-management/inflammatory-arthritis-self-management

Mary Pack Arthritis Classes: https://www.vch.ca/en/service/mary-pack-arthritis-program-arthritis-classes#wysiwyg–113261

How is rheumatoid arthritis treated?

The first line treatment for rheumatoid arthritis is methotrexate. This is either an oral or injection that is taken once per week. Up to 50% of patients with rheumatoid arthritis can go into remission with methotrexate alone

RheumInfo: Methotrexate: https://rheuminfo.com/en/medications/methotrexate/

Learn How to Inject: Subcutaneous Injections: https://rheuminfo.com/living-with-arthritis/learn-how-to-inject-subcutaneous-injections/

Learning to Self Inject Methotrexate at Home: https://rheuminfo.com/docs/living-with-arthritis/Methotrexate-Injection-Sheet-RheumInfo.pdf

What can I do to help control my rheumatoid arthritis?

Exercise. Regular exercise improves pain and inflammation in rheumatoid arthritis. The general recommendation is at least 30 minutes of moderate to vigorous activity five times per week. Moderate to vigorous is defined as difficult to breath, but able to hold a conversation. Strength training twice per week is also important to build muscle.
Diet. The best diet supported by evidence is the Mediterranean diet. This diet is high in omega 3. It is mainly comprised of fish (twice weekly), fruits and vegetables, nuts and olive oil. Try to reduce your consumption of packaged and processed foods (e.g., bread that has additives, premade salad dressings, etc.)
Alcohol. Reduce alcohol intake, ideally to none. There are great alcohol-free alternatives on the market.
Smoking. If you smoke, you should discuss strategies for quitting with your primary care practitioner or pharmacist. Smoking can make rheumatoid arthritis worse.

What other medication options are there?

Other treatment options include hydroxychloroquine, leflunomide and sulfasalazine. These are called “conventional synthetic DMARDs (csDMARDs)”.

If these medications do not work, biologics are an option. Biologics are advanced therapies that target a specific part of the immune system that causes rheumatoid arthritis.

These medications are very expensive (over $1,000 per month), but are covered by BC Pharmacare for patients who meet criteria. To meet criteria, patients must:

Have a diagnosis of rheumatoid arthritis
Tried methotrexate injection with sulfasalazine and hydroxychloroquine or leflunomide or
Have tried another similar combination of medications and
Have active disease or side effects