In recent years the medical community has promoted treating rheumatoid arthritis early and aggressively. They point out that by taking rheumatoid arthritis medications such as disease-modifying antirheumatic drugs (DMARDs) early, patients can delay problems such as joint damage, loss of function, disability and deformity.

But, is early aggressive treatment for rheumatoid arthritis always the best approach? It's not quite clear.

According to the Johns Hopkins Arthritis Center, early DMARD therapy significantly improves joint function, grip strength, morning stiffness, general wellbeing and pain and erythrocyte sedimentation rate (ESR), which measures inflammation in the body.

But, they point out that the clinical improvements made in the first year of DMARD treatment might not be sustained if the treatment is discontinued. However, they won't support or refute early aggressive treatment for RA.

Still, it does leave the question slightly open about whether early aggressive DMARD treatment is definitively better, or if there are other approaches that can be just as effective, such as adding biologics to the regimen as some researchers advocate.

Do Mild Cases of Rheumatoid Arthritis Need Early Aggressive Treatment?

Furthermore, while rheumatoid arthritis is a chronic condition in most cases, for a small minority of people the disease may not progress to the stage where it ravages their joints and signals a future of disability.

In some cases, blood tests for RA may not be conclusive. You may need for some time to pass so that imaging tests can determine if you've had any joint damage or other symptoms of RA. Some people go years between arthritis flares, with little damage occurring to their joints.

In 2008, the American College of Rheumatology recommended hydroxychloroquine or minocycline for people with mild rheumatoid arthritis that has been present for less than two years. They also recommended the DMARDs methotrexate or leflunomide for all stages of the disease, whether or not they had a poor prognosis.

Making Your Decision

Only you and your doctor can decide on the best course of treatment for rheumatoid arthritis once you are diagnosed. As doctors cannot predict who will develop severe joint damage from rheumatoid arthritis, treatment will depend on several factors.

These include blood tests and imaging results, duration of your symptoms, joint function, and your medical status. While early aggressive treatment with DMARDs may significantly reduce the risk of disability in the future, it also carries risks, so make sure you understand what you're getting in to.

Also, you need to take the drugs for several months before you see any improvement, so you'll often have to take them with other rheumatoid arthritis drugs such as NSAIDs or corticosteroids.

If it turns out that early aggressive treatment with DMARDs is not right for you, there are other strategies you can combine with medications such as NSAIDS and hydroxychloroquine to combat rheumatoid arthritis in the early stages:

1. Lose weight. People who are overweight or obese have worse rheumatoid arthritis symptoms, and may respond less favorably to drug treatment. Also, being obese can reduce your chances of going into arthritis remission.

2. Strengthen and flex your muscles. Strengthening and flexibility exercises help to relieve pain and inflammation, and improve motor function. Ask your doctor for a referral to a physical therapist who can teach you the most effective exercises to build muscles and strengthen joint structures.

3. Reduce stress. For many people stress is a chronic condition, and studies show that it can trigger rheumatoid arthritis. It affects the immune and endocrine systems, possibly increasing disease activity in your body.

Stress also limits your ability to mentally cope with disease, including rheumatoid arthritis. This impacts your perception of pain or fatigue associated with RA and may deter you from being active, making your RA worse in the short and long term.

4. Switch to a vegan or vegetarian diet. Research suggests that eating a diet that's gluten free and full of fruits, vegetables, nuts and seeds can alter some of the mechanisms in the body that contribute to chronic inflammation.