Introduction to Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a long-term autoimmune condition in which the immune system mistakenly attacks the body’s own joints. This ongoing inflammation leads to symptoms such as joint swelling, stiffness, and persistent pain, which can become severe if not properly managed. Over time, untreated or poorly controlled RA can result in further joint damage, loss of function, and even disability. The primary goals of treatment are to reduce inflammation, relieve pain, and prevent further joint damage. Healthcare professionals often recommend a combination of medications, lifestyle changes, and occupational therapy to help patients manage their symptoms and maintain their quality of life. By working closely with your healthcare team, you can find a treatment plan that addresses your unique needs and helps you live well with rheumatoid arthritis.
Introduction to Rheumatoid Arthritis Injections
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes joint pain, swelling, and inflammation. Early intervention and starting treatment at the beginning of RA is important to improve outcomes and help manage symptoms more effectively. For many patients, injections are a key part of RA treatment, providing targeted relief and helping to slow disease progression. Injections can deliver medication directly into the joint or systemically, reducing inflammation and improving quality of life. This guide covers the main types of injections for RA, their effectiveness, risks, and how they fit into a comprehensive treatment plan. In most cases, injections are effective in managing symptoms. Patients may have concerns about injections, and it is important to discuss any worries with their healthcare provider.
Types of Injections for Rheumatoid Arthritis
- Corticosteroid (Steroid) Injections: These drugs are injected directly into inflamed joints to quickly reduce pain and swelling. Common steroids include triamcinolone and methylprednisolone. Relief can last weeks to months, but repeated use may damage cartilage. Steroid injections are often recommended to manage symptoms of inflammatory arthritis, including rheumatoid arthritis and psoriatic arthritis, by targeting joint inflammation directly.[1]
- Biologic Injections (Biologic DMARDs): Biologics are advanced prescription drugs that target specific parts of the immune system and are used to treat RA and related inflammatory arthritis conditions. Some biologic drugs work by blocking TNF (tumor necrosis factor) and are known as TNF blockers, which help prevent joint damage and improve symptoms. These drugs are usually administered as a subcutaneous injection, and some, like tocilizumab (Actemra), are available as an injection pen for convenient home use. Examples include adalimumab (Humira), etanercept (Enbrel), and tocilizumab (Actemra). The recommended dose and administration schedule should always be followed as prescribed by a healthcare professional. Biologics are often used when patients have not been adequately treated with other medications.[2]
- Other DMARDs: Some disease-modifying antirheumatic drugs (DMARDs) are prescription medications given by injection, such as methotrexate (subcutaneous) or abatacept (Orencia). These drugs are used to treat RA and other forms of inflammatory arthritis, including psoriatic arthritis.
- Hyaluronic Acid Injections: This drug is rarely used for RA but may be considered for joint lubrication in other types of inflammatory arthritis, such as osteoarthritis.
- Prolotherapy: See Prolotherapy below for details. Prolotherapy is used to treat RA and can also be considered for other inflammatory arthritis conditions.
How Effective Are RA Injections?
- Steroid injections: Provide rapid relief of joint pain and swelling, but effects are temporary (weeks to months). Not recommended for frequent, long-term use due to risk of cartilage damage.
- Biologic injections: Highly effective for many patients, reducing inflammation, slowing joint damage, and improving function. They are often used when conventional DMARDs are not sufficient.[2] It may take a few weeks to notice the full effects of these treatments.
- DMARD injections: Can help control disease activity and prevent joint damage over time, helping to prevent further damage to joints and surrounding tissues.
The choice of injection depends on disease severity, previous treatments, and individual risk factors. Patients with severe rheumatoid arthritis may require more aggressive injection therapies. Injections are often combined with oral medications, physical therapy, and lifestyle changes for best results.
Risks and Side Effects
- Steroid injections: Risk of joint infection, cartilage damage, skin thinning, and elevated blood sugar (especially in diabetics). Other side effects can include weight gain and increased blood pressure, so it is important to monitor these parameters during treatment.
- Biologics: Increased risk of infections (including tuberculosis), injection site reactions, and rare immune-related side effects. Screening for hepatitis B and tuberculosis is required before starting biologics.
- All injections: Possible allergic reactions, pain, or swelling at the injection site. Some patients may experience a flare up of symptoms after an injection, which should be monitored and managed appropriately.
Discuss risks and benefits with your rheumatologist before starting any injection therapy.
Injection Procedure & Monitoring
Steroid injections are usually performed in a clinic, often with ultrasound guidance for accuracy. The joint is cleaned, numbed, and the medication is injected. Biologic and DMARD injections may be self-administered at home (subcutaneous) or given by a healthcare professional (IV infusion). Regular monitoring is essential to assess effectiveness, manage side effects, and adjust treatment as needed.
Interactions with Other Medications
If you are taking methotrexate or other medications to treat rheumatoid arthritis, it’s important to be aware of how these drugs may interact with other prescriptions or over-the-counter medicines. For example, combining methotrexate with certain antibiotics can increase the risk of side effects, while tumor necrosis factor (TNF) blockers may interact with other medications and raise the risk of infections. In some cases, your doctor may recommend a loading dose to help your body adjust to a new medication, but this should always be done under medical supervision. To minimize risks, always inform your doctor about all the medications and supplements you are taking. This helps your healthcare team adjust your treatment plan and monitor for any potential interactions, ensuring you receive the safest and most effective care possible.
Fertility, Pregnancy, and Breastfeeding Considerations
Women with rheumatoid arthritis who are planning to become pregnant, are currently pregnant, or are breastfeeding should have an open discussion with their doctor about their treatment options. Certain medications, such as methotrexate, carry a risk of birth defects and should be avoided during pregnancy. Some drugs can also pass into breast milk and may affect the baby, so it’s essential to review all medications with your healthcare provider before starting or continuing treatment. Your doctor can help you weigh the risks and benefits of each medication and recommend safer alternatives if needed. By working closely with your healthcare team, you can manage your RA effectively while minimizing potential risks to both you and your baby during pregnancy and breastfeeding.
Case Study: Biologic Injections for RA
A 52-year-old patient with moderate RA and persistent joint pain despite oral methotrexate was treated with adalimumab (Humira) injections, a biologic drug. Within three months, the patient reported a 70% reduction in pain and swelling, improved hand function, and fewer morning stiffness episodes. After one year, X-rays showed no further joint damage. The patient continued regular monitoring and physical therapy for optimal results.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat rheumatoid arthritis.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with rheumatoid arthritis.
As prolotherapy is helping to treat the root cause of rheumatoid arthritis, it is deemed to be a permanent fix, preventing the symptoms from returning.[3]
Complementary Therapies for Rheumatoid Arthritis
Many patients with rheumatoid arthritis explore complementary therapies to help relieve pain and manage symptoms alongside their prescribed medications. While there is limited evidence supporting the effectiveness of these therapies, some people find that options like acupuncture, massage, or yoga can help reduce stress, improve mood, and ease discomfort. It’s important to talk to your doctor before starting any complementary therapy, as some treatments may interact with your medications or have unintended side effects. A holistic approach that combines conventional treatments with healthy lifestyle changes—such as a balanced diet, regular exercise, and stress management—can often provide the best results. By working with your healthcare team, you can find a combination of therapies that supports your overall well-being and helps you manage the challenges of rheumatoid arthritis.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating rheumatoid arthritis, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with rheumatoid arthritis and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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Frequently Asked Questions
What are the main injections for rheumatoid arthritis?
Steroid (corticosteroid) injections, biologic DMARDs (e.g., adalimumab, etanercept), and injectable methotrexate are commonly used for RA.
How long do RA injections last?
Steroid injections last weeks to months; biologics and DMARDs require ongoing, regular administration for continued benefit.
Is prolotherapy safe for rheumatoid arthritis?
Prolotherapy is considered safe when performed by a qualified practitioner and has shown promising results for RA pain and function.[3]
Can injections cure rheumatoid arthritis?
No injection cures RA, but they can control symptoms, reduce inflammation, and slow joint damage as part of a comprehensive treatment plan.
References
- NHS. (2023). Steroid injections. https://www.nhs.uk/conditions/steroid-injections/
- Arthritis Foundation. (2023). Biologics for Rheumatoid Arthritis. https://www.arthritis.org/health-wellness/treatment/treatment-plan/medication/biologics-for-ra
- Rabago, D., et al. (2016). Prolotherapy in Primary Care Practice. Primary Care: Clinics in Office Practice, 43(2), 329-338. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913113/