Treatment aim 1 - to reduce pain and stiffness

During a flare-up of inflammation, if you rest the affected joint(s) it helps to ease pain. Special wrist splints, footwear, gentle massage, or applying heat may also help. Medication is also helpful. Medicines which may be advised by your doctor to ease pain and stiffness include the following.

Non-steroidal anti-inflammatory painkillers

These are sometimes just called 'anti-inflammatories' and are good at easing pain and stiffness. There are many types and brands. Each is slightly different to the others, and side-effects may vary between brands. To decide on the right brand to use, a doctor has to balance how powerful the effect is against possible side-effects and other factors. Usually one can be found to suit. However, it is not unusual to try two or more brands before finding one that suits you best.

The leaflet which comes with the tablets gives a full list of possible side-effects. The most common side-effect is stomach pain (dyspepsia). An uncommon but serious side-effect is bleeding from the stomach. Your doctor may prescribe another medicine to 'protect the stomach' from these possible problems. If you develop abdominal (stomach) pains, pass blood or black stools, or vomit blood whilst taking anti-inflammatory painkillers, stop taking the tablets and see a doctor soon.

Painkillers

Paracetamol often helps. This does not have any anti-inflammatory action, but is useful for pain relief in addition to, or instead of, an anti-inflammatory painkiller. Codeine is another painkiller that is sometimes used.

Steroids

Steroids are good at reducing inflammation. However, because of the problem of possible side-effects, steroids are not recommended for routine use. This is not to say that they are never used. The main side-effects from steroids occur when they are used for more than a few weeks. Therefore, a short course of steroid tablets such as prednisolone is sometimes used. This may be prescribed to treat a flare-up which has not been helped much by a non-steroidal anti-inflammatory. A short course of steroids may also be used whilst waiting for a disease modifying drug (see below) to take effect.

An injection of steroid directly into a joint is sometimes used to treat a bad flare-up in one particular joint.

The serious side-effects that may occur if you take steroids for more than a few weeks, or if you have injections frequently, include: thinning of the bones (osteoporosis), thinning of the skin, weight gain, muscle wasting and an increased risk of serious infection.

Note: non-steroidal anti-inflammatories, ordinary painkillers, and steroids ease the symptoms of RA. However, they do not alter the progression of the disease or prevent joint damage. You do not need to take them if symptoms settle between flare-ups.

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