By Dr. Devender Bairwa, Consultant Rheumatologist | StepUp Joints, Lajpat Nagar, South Delhi
A diagnosis of rheumatoid arthritis (RA) no longer means accepting a future of progressive joint damage, deformity and disability. Over the last few decades, advances in rheumatology have transformed the way we treat this autoimmune disease. Today, our goal is not simply to reduce pain—it is to control the underlying inflammation, prevent structural joint damage and, whenever possible, achieve sustained clinical remission.
As a practicing rheumatologist at StepUp Joints, Lajpat Nagar, South Delhi, I frequently see patients who have lived with rheumatoid arthritis for years believing that painkillers are their only option. Modern treatment has changed this approach fundamentally.
From symptom control to disease control
Traditional painkillers and anti-inflammatory medicines can provide symptomatic relief, but they do not adequately suppress the autoimmune process responsible for rheumatoid arthritis. This is where disease-modifying antirheumatic drugs (DMARDs) play a central role.
Conventional DMARDs such as methotrexate, leflunomide and sulfasalazine can suppress disease activity and reduce the risk of long-term joint damage. Methotrexate remains an important first-line treatment for many patients.
However, some patients continue to have active disease despite conventional DMARD therapy. This is where targeted therapies have made a remarkable difference.
The era of biologics and targeted therapies
Biologic DMARDs are medicines designed to target specific molecules or pathways involved in rheumatoid arthritis inflammation. Depending on the patient’s disease characteristics, these may target pathways involving TNF, IL-6, B cells or T-cell activation.
In addition, targeted synthetic DMARDs, particularly JAK inhibitors, work on intracellular signaling pathways involved in immune activation.
These therapies can produce a profound reduction in inflammation. For appropriately selected patients, they can lead to clinical remission or low disease activity, sometimes after years of inadequate control with older treatments.
What does remission actually mean?
Remission does not simply mean that the patient feels better for a few days. It means achieving minimal or no clinically detectable inflammatory disease activity, assessed using symptoms, physical examination and validated disease-activity measures.
Importantly, treatment should be individualized and regularly monitored. If disease activity remains significant despite one DMARD, the treatment strategy may need to be intensified or changed. This “treat-to-target” approach has become a cornerstone of modern rheumatoid arthritis management.
Early treatment makes a difference
The greatest opportunity to prevent irreversible joint damage is often early in the disease course. Delaying effective treatment can allow inflammation to continue silently and cause permanent structural damage.
Modern rheumatology therefore aims for much more than temporary pain relief. The objective is to diagnose RA early, suppress inflammation rapidly, prevent joint damage, preserve function and help patients achieve sustained remission whenever possible.
For patients with rheumatoid arthritis, this means there is genuine reason for optimism. With timely diagnosis, appropriate DMARD therapy, targeted biologics or other advanced treatments when indicated, and regular monitoring, many patients can lead active and fulfilling lives with their disease under excellent control.
At StepUp Joints, Lajpat Nagar, South Delhi, my approach is to select treatment based on the individual patient’s disease activity, comorbidities, treatment history, safety considerations and personal goals—because modern rheumatoid arthritis care is not one treatment fits all.
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