Massage therapy · Kitchener–WaterlooRheumatoid Arthritis

A Mediterranean-style diet is recommended (NHS, 2023c). This is based on

• vegetables and fruit
• beans, legumes and nuts
• cereals, grains and bread
• fish
• unsaturated fats, such as olive oil, in place of butter and cheese
• less meat (NICE, 2018)

There is little evidence supporting the use of supplements in rheumatoid arthritis (NHS, 2023c). Check with your healthcare team before taking any over-the-counter remedies, such as painkillers or nutritional supplements, as these may interfere with your medicine (NHS, 2023d).

If you suffer with RA, then exercise is really important. Low-impact exercises such as swimming, cycling, walking and aqua aerobics can be beneficial (NHS, 2023d).

1. Medication

There is no cure for rheumatoid arthritis, but early diagnosis and treatment can stop it getting worse and reduce the risk of joint damage (NHS, 2023a). Your treatment will usually involve your family doctor or nurse practitioner and several different specialists, and medicines for RA are prescribed and monitored by them. The main types are listed below under "Treatments you may want to discuss with your family doctor or nurse practitioner". Take your medicine as instructed, even if you start to feel better (NHS, 2023d).

2. Exercise

Exercise can help keep your joints mobile and strengthen the muscles supporting your joints (NHS, 2023d). It is important to find a balance between rest and exercise: rest will make inflamed joints feel more comfortable, but without movement your joints will stiffen and your muscles will become weaker. Increase the amount of exercise gradually. If an activity makes your joints warm and swollen or causes severe pain, stop and rest (NHS, 2023d).

3. Therapy

A physiotherapist can help you improve your fitness and muscle strength, and make your joints more flexible (NHS, 2023c). An occupational therapist can give advice on protecting your joints at home and at work (NHS, 2023c).

Options outside my scope

• Disease-modifying anti-rheumatic drugs (DMARDs): medicines such as methotrexate (usually the first one given), leflunomide, hydroxychloroquine and sulfasalazine, which ease symptoms and slow down the progress of the condition (NHS, 2023c).
• Biological treatments: injected medicines such as adalimumab, etanercept and infliximab, usually used with a DMARD when DMARDs alone have not worked (NHS, 2023c).
• JAK inhibitors: a newer type of medicine for moderate to severe RA, offered when DMARDs or biological treatments are not suitable or have not worked (NHS, 2023c).
• Steroids: powerful medicines, given as tablets or injections, usually used for short-term relief while waiting for DMARDs to work or during a flare-up (NHS, 2023c).
• Pain relief and anti-inflammatory medicines: painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain, but they do not stop rheumatoid arthritis getting worse (NHS, 2023c).
• Surgery: if joints become damaged despite medicine, surgery may be recommended to restore use of the joint, reduce pain or correct deformities, for example a joint replacement (NHS, 2023c).

How I can help (see the My Approach tab)

With RA I avoid strong movement of the top of the neck, and I work around any rheumatoid nodules. If you've had joint surgery, I need your surgeon's okay before hands-on work near it; then scar work and strengthening follow their plan. If you have a fever, we'll reschedule. If pain lasts more than about an hour after treatment or exercise, we've done too much and we scale back.