“The primary cause of RA pain is inflammation that swells joint capsules,” says Yousaf Ali, MBBS, a professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai West Hospital in New York City. Joint capsules are thin sacs of fluid that surround a joint, providing lubrication for bone movement. In RA, the body’s immune system attacks those capsules. The first step toward pain relief is controlling the underlying inflammation, Dr. Ali explains. “Inflammation can cause acute [short-term] pain or longer-lasting, smoldering pain,” he says. “Chronic erosion of joint tissues over time is another cause of chronic pain. But there are many options for pain relief.” Getting RA pain under control may take some work. You may need to take several drugs — some to slow joint damage and some to alleviate joint pain — as well as experiment with lifestyle adjustments and alternative therapies to find relief. It may take some time, too.
Treatments and Strategies to Help Relieve Chronic RA Pain
Try the following strategies — with your doctor’s supervision — to discover which are most effective for you.
1. Medication to Control Inflammation
“In the case of RA, all other pain-relief strategies are secondary to controlling inflammation,” Ali says. That means treating with medications that alter the course of the disease — such as traditional disease-modifying anti-rheumatic drugs (DMARDs) or more targeted options like biologic drugs or Janus kinase (JAK) inhibitors. These drugs each work differently to suppress the body’s overactive immune system response and are also used to prevent joint damage and slow the progression of the disease. They’re often prescribed shortly after an RA diagnosis in order to prevent as much joint damage as possible — though it may take up to six months or so to fully feel the drug’s benefits. It can also take time to find the right treatment — or combination of treatments — to help you gain control of RA. “Steroids may also be used to bridge the gap during an acute flare,” adds Ali, though they are typically only used for a short period of time, due to the side effects they are associated with. “Stronger pain relievers, called opioids, may be used for severe pain, but we try to avoid them if possible,” says Ali. “These drugs must be used cautiously because of the potential to build up tolerance, which can lead to abuse.”
3. Exercise
Although you may not feel like exercising when you have RA — and it might seem like being active could put stress on your joints — guidelines from the American College of Rheumatology (ACR) state that exercising consistently is one of the best things you can do to manage your condition. That includes incorporating a mix of activities into your workout routine, including:
Aerobic exerciseAquatic exerciseResistance exerciseMind-body exercise
What’s more, gentle exercises may even help reduce muscle and joint pain. “Non-impact or low-impact exercise is a proven way to reduce pain,” Ali says. “I recommend walking, swimming, and cycling.” In fact, one of the best exercises you can do for RA is water aerobics in a warm pool, as the buoyancy of exercising in water reduces stress on your joints. The Arthritis Foundation recommends yoga as another option to help reduce RA pain, and traditional yoga poses can be modified to your abilities. Yoga may also help improve the coordination and balance that is sometimes impaired when you have the disease. When it comes to exercise, though, be sure to use caution. Talk with your doctor if any workouts are making your pain worse, and in general, put any exercise plan on hold during an RA flare.
4. Diet
Up until recently, there was no one diet backed by the medical community to help manage RA. However, the ACR guidelines are now emphasizing the Mediterranean diet. That means focusing on eating plenty of:
Whole grainsVegetablesFruitsLegumesNutsSeedsHealthy fats
In fact, some evidence suggests omega-3 fatty acids, found in cold-water fish like salmon, can help reduce inflammation and the joint pain that results from it. Just be sure to get healthy fats through the foods you eat. The ACR advises that dietary supplements may not offer the same benefits.
5. Weight Management
Reaching and maintaining a healthy weight may help alleviate joint pain. One study found that people with RA and obesity who lost about 11 pounds on average experienced improvements in disease activity.
6. Heat and Cold
Heat helps to relax muscles, while cold helps to dull the sensation of pain. You might find that applying hot packs or ice packs, or alternating between hot and cold, helps reduce your joint pain. Relaxing in a hot bath can also bring relief, as can exercising in a warm pool.
7. Orthoses
These mechanical aids can help support and protect your joints. Examples include padded insoles for your shoes and splints or braces that keep your joints in proper alignment. You can even get special gloves for affected hand and finger joints. Work with a physical therapist to help determine the best orthoses options for you.
8. Massage
A massage from a therapist (or even a DIY massage) can be a soothing complementary therapy to help reduce muscle and joint pain. According to the Arthritis Foundation, it’s best to first check with your doctor to get the green light to try massage, as certain techniques apply a lot of pressure to your muscles and joints. Once you have your doctor’s approval, be sure to tell your massage therapist that you have RA. And remember: Massage should make you feel better, not worse.
9. Acupuncture
This Eastern medicine practice has been around for centuries and is thought to work by stimulating the body’s natural painkillers through the use of fine needles gently placed near nerve endings. “Acupuncture can be helpful for some patients, but the pain relief is usually not long-lasting,” says Ali.
Work With Your Doctor
Remember, you’re not alone — your RA care team can help you find relief from chronic pain. If you’re experiencing more pain than before, or if pain is interfering with your ability to get things done, don’t hesitate to talk to your doctor. Ask your rheumatologist about pain relief options, like exercise, massage, and acupuncture, but remember that your first priority should be to get RA inflammation under control. Additional reporting by Erica Patino and Brian Dunleavy.
