Preventing Bone Erosion in Rheumatoid Arthritis

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Rheumatoid arthritis can destroy the structures that protect, cushion and lubricate joints, leading to irreversible bone damage. Living an active lifestyle and following your medication plan are two key strategies for preventing or reducing bone erosion in rheumatoid arthritis.

How Chronic Inflammation Damages Your Joints

In rheumatoid arthritis (RA), the body’s immune system attacks healthy joint tissue, causing chronic inflammation. Left untreated, this inflammation eventually destroys structures within the joint capsule, leading to the loss of lubricating fluid, and creating friction when the bones bend, rotate and glide. In severe rheumatoid arthritis, the bones inside the joint may rub against each other, causing erosion of the bone surfaces.

When it occurs, joint damage in RA is permanent and irreversible, but you can take steps to prevent it or slow it down. After an RA diagnosis, your doctor will develop a treatment plan that includes one or more RA medications that directly disrupt the inflammatory process. Lowering inflammation helps lessen pain and keep your joints healthy.

Rheumatoid Arthritis Medications to Prevent Joint Damage

The primary goal of RA treatment is to reduce systemic inflammation, which is inflammation present throughout your body. Your doctor may prescribe several different types of RA medications, depending on how severe and active your disease. Initial treatment tends to be very aggressive, to get inflammation down as quickly as possible. Ongoing treatment focuses on medications to keep inflammation low over the rest of your life.

Drugs that reduce RA disease activity like inflammation fall into four general categories: corticosteroids, traditional disease-modifying antirheumatic drugs (DMARDs), biologics, and JAK inhibitors. Because RA’s inflammatory effects are mediated through an abnormal autoimmune reaction, many RA drugs target the immune system.

Corticosteroid medications for RA

These strong, fast-acting anti-inflammatory medications may be prescribed early in the course of treatment or during a flare-up. Corticosteroid drugs like prednisone, prednisolone and methylprednisolone quickly reduce inflammation throughout the body. Doctors do not generally prescribe these drugs as long-term therapy for RA, however, due to potential side effects like weight gain, diabetes, thinning skin, and cataracts.

Traditional DMARDs for RA

As the name implies, DMARDs change or block the disease’s ability to cause inflammation. DMARDs act on the immune system. Many people with RA receive a traditional DMARD over the course of the disease to keep disease activity low. Common traditional DMARDs include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. These medications not only treat the disease itself but provide relief of many symptoms, such as pain and stiffness. Your doctor may prescribe DMARDs in pill form, as an injection, or by intravenous infusion in the medical office.

Biologics for RA

A newer class of drugs—biologics—target specific aspects of the RA disease process to prevent joint damage. Biologics often work by disrupting the immune system’s chemical signaling, thereby inhibiting the inflammatory response. Most patients receive a biologic by infusion. Some patients are prescribed a biologic with a traditional DMARD to put the disease into remission and keep it there. Currently approved biologic therapies for rheumatoid arthritis include abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab and tocilibumab.

JAK inhibitors for RA

These medications block a specific chemical pathway involved in the body’s immune response. This pathway uses an enzyme called Janus kinase (JAK) to provoke inflammation. JAK inhibitors prevent the immune system from using the JAK pathway, and this lowers inflammation throughout the body and within the joints. Currently, two JAK inhibitors are approved for use in treating RA: tofacitinib and baracitinib. JAK inhibitors come in pill form and may be prescribed to people who cannot tolerate methotrexate treatment or whose disease proves resistant to treatment by traditional DMARDs.

A Holistic Approach to Preventing Joint Damage in Rheumatoid Arthritis

Adhering closely to your medication plan over the long term can help you avoid RA flares and permanent joint damage like bone erosion. Being physically active and making certain other lifestyle choices can help you live well with RA.

Try these types of fitness routines:

  • Engage in low-impact aerobic exercise like walking or water aerobics classes to maintain joint flexibility and for overall good health.

  • Perform stretching and range-of-motion exercises every day to keep your joints limber.

  • Strengthen joint-supporting muscles and relieve joint strain by lifting weights. Weight training also helps with bone strength.

Before starting an exercise program or lifting weights, check with your doctor, a physical therapist, or an athletic trainer on the safest weight and activity for you.

Advances in medications for rheumatoid arthritis have significantly improved the prognosis for this chronic disease. Many people with rheumatoid arthritis live normal lives free from joint damage or serious effects like bone erosion.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Apr 26
  1. Rheumatoid Arthritis. MedlinePlus, U.S. National Institutes of Health, MedlinePlus.
  2. Rheumatoid Arthritis. U.S. Arthritis Foundation.
  3. Rheumatoid Arthritis. American College of Rheumatology.
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