Rheumatoid Arthritis Drug Types
Rheumatoid arthritis (RA) is an inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment.
Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. Starting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches.
You may take rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of RA medications:
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Biologic response modifiers (a type of DMARD)
- Glucocorticoids
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Analgesics (painkillers)
In the past, doctors took a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with NSAIDs such as ibuprofen. Then, they progressed to more potent RA drugs for people who showed signs of joint damage.
Today, doctors know that an aggressive approach is often more effective; it will result in fewer symptoms, better function, less joint damage, and less disability. The goal, if possible, is to put the disease into remission.
Rheumatoid Arthritis Drugs: DMARDs
If you've been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of DMARDs within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, DMARDs can often slow or stop RA from getting worse by interrupting the immune process that promotes inflammation. But they may take up to 6 months to be fully effective.
DMARDs have greatly improved the quality of life for many people with rheumatoid arthritis. These RA drugs are often used along with NSAIDs or glucocorticoids. But with this type of medication, you may not need other anti-inflammatories or analgesics.
Because DMARDs target the immune system, they also can weaken the immune system's ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to make sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or kidneys.
Examples of DMARDs:
| Name | Brand Name(s) | Precautions | Potential Side Effects |
| hydroxychloroquine sulfate | Plaquenil | Tell your doctor if you have vision problems; vision may be damaged with high doses or long-term use. | • Blurry vision or increased light sensitivity • Headache • Belly cramps or pain • Loss of appetite, nausea, vomiting, or diarrhea • Itching or rashes |
| leflunomide | Arava | Tell your doctor if you have: Stop taking leflunomide before trying to conceive. | • Dizziness • Hair loss • Headache • Heartburn • High blood pressure • Gastrointestinal or liver problems • Low blood cell count • Neuropathy • Skin rash |
| methotrexate | Rheumatrex, Trexall | Tell your doctor if you have: • Abnormal blood counts • Liver or lung disease • Alcoholism• Active infection or hepatitis • Active plans to conceive | • Belly pain
Dry cough, fever, or trouble breathing, which may result from lung inflammation |
| tofacitinib | Xeljanz | • Xeljanz adds to risk of serious infections, cancers, lymphoma. • May increase cholesterol levels and liver enzymes • May lower blood count | • Upper respiratory tract infection • Headache • Diarrhea • Inflammation of the nasal passage and the upper part of the throat • Blood clots and tears in the intestine |
| baricitinib | Olumiant | • Olumiant increases the risk of serious infections, cancers, lymphoma. • May raise cholesterol levels and liver enzymes • May lower blood count | • Upper respiratory tract infection • Headache • Diarrhea • Inflammation of the nasal passage and the upper part of the throat • Blood clots and tears in the intestine |
| Upadacitinib | Rinvoq | • Rinvoq increases the risk of serious infections, cancers, lymphoma, and skin cancers. | • Upper respiratory infections • Cough • Fever • Nausea • May cause blood clots • Tears in the stomach and intestines are possible. |
Minocycline (Minocin) is an antibiotic that is not often prescribed. But it may help RA by stopping inflammation. It can take several months to start working and up to a year before the full effects are known. When taken for long periods, minocycline can discolor the skin.
Are DMARDs Safe?
Many people take DMARDs without ever having problems. But because they work throughout the body to fight RA, their powerful action typically does cause some side effects, commonly:
- Stomach upset. DMARDs sometimes cause nausea, sometimes with vomiting, or diarrhea. Other medicines can help treat these symptoms, or they often improve as you get used to the drug. If the symptoms are too uncomfortable to tolerate, your rheumatologist will try a different medication.
- Liver problems. These are less common than stomach upset. Your doctor will check blood tests on a regular basis to make sure your liver is not being harmed.
- Blood problems. DMARDs can affect the immune system and raise the risk of infection. Infection-fighting white blood cells may also be decreased. Low red blood cells (anemia) can make you feel tired more easily. A simple blood test by your doctor every so often will make sure your blood counts are high enough.
You should learn about possible side effects of any medicine you are taking and discuss them with your doctor until you feel comfortable.
To lessen side effects, DMARDs are sometimes started one at a time and increased gradually. The goal is to lessen both rheumatoid arthritis disease activity and medication side effects. It often takes more than one DMARD to get control of active rheumatoid arthritis.
Rheumatoid Arthritis Drugs: Biologic Response Modifiers
Biologic response modifiers are a type of DMARD. They target the part of the immune system response that leads to inflammation and joint damage. By doing this, they can improve your condition and help relieve symptoms.
These RA medications can't cure rheumatoid arthritis. If the drugs are stopped, symptoms may return. But just as with other DMARDs, biologic response modifiers may slow the progression of the disease or help put it into remission. If your doctor prescribes one of these RA drugs, you will likely take it along with methotrexate. Biologic response modifiers are taken by injection and/or by IV and are expensive. Their long-term effects are unknown.
NOTE: Before taking biologics, it's important to get the vaccinations you need and to be tested for tuberculosis and hepatitis B and C.
Examples of biologic response modifiers:
| Name | Brand Name | Precautions | Potential Side Effects |
| abatacept | Orencia | • Tell your doctor if you have a serious infection, such as pneumonia or COPD. • Do not take live vaccines. • Get tested for TB and hepatitis before starting treatment. | • Cough • Dizziness • Headache • Serious infection • IV reaction • Serious infections, like TB, and infections from bacteria, viruses, or fungi |
| adalimumab | Humira | • Tell your doctor if you have a serious infection, such as pneumonia. • Do not take live vaccines. • Get tested for TB and hepatitis before starting treatment. | • Redness, pain, itching, or bruising where you got the shot • Upper respiratory infection • Serious infections, like TB, and infections from bacteria, viruses, or fungi |
| adalimumab-atto | Amjevita, a biosimilar to Humira | • Tell your doctor if you have congestive heart failure. • Your doctor should test you for tuberculosis and hepatitis. | • Reactions where you got the shot • Upper respiratory infections • Rash • Headaches • Serious infections, such as tuberculosis and sepsis, and infections from bacteria, viruses, or fungi • Higher risk for lymphoma and other cancers |
| anakinra | Kineret | • Tell your doctor if you have a serious infection or a history of it. • Do not take live vaccines. | • Redness, swelling, pain, or bruising where you got the shot • Low white blood cell count • Upper respiratory infection • Serious infections, like TB, and infections from bacteria, viruses, or fungi |
| etanercept | Enbrel | Do not take if you have congestive heart failure, and tell your doctor if you have: Do not take live vaccines. | • Redness, pain, itching, swelling, or bruising at injection site Rare complications: |
| etanercept-szzs | Erelzi, a biosimilar to Enbrel
| Do not take if you have congestive heart failure, and tell your doctor if you: Do not take live vaccines. | • Redness, pain, itching, swelling, or bruising at injection site Rare complications: |
| infliximab | Remicade | • Tell your doctor if you have a serious infection or a history of it. • Tell your doctor if you are taking concomitant immunosuppressants such as corticosteroids or methotrexate • Do not shake before administering | • Headache Rare complications include increased risks for: • Development of tuberculosis |
| Infliximab-abda | Renflexis | • Tell your doctor if you have a serious infection or a history of it. • Tell your doctor if you are taking concomitant immunosuppressants such as corticosteroids or methotrexate • Do not shake before administering | • Headache Rare complications include: • Development of tuberculosis |
| infliximab-dyyb | Inflectra | • Tell your doctor if you have a serious infection or a history of it. • Tell your doctor if you are taking concomitant immunosuppressants such as corticosteroids or methotrexate • Do not shake before administering | • Headache Rare complications include increased risk for: • Development of tuberculosis |
| rituximab | Rituxan | • Tell your doctor if you have a serious infection, or heart or lung disease. • Tell your doctor if you are taking immunosuppressants such as methotrexate or corticosteroids. | • Belly pain Serious side effects: |
| rituximab-abbs | Truxima | • Tell your doctor if you have a serious infection, or heart or lung disease. • Do not take live vaccines. | • Belly pain Serious side effects: |
| rituximab-pvvr | Ruxience | • Tell your doctor if you have a serious infection, or heart or lung disease. • Do not take live vaccines. | • Belly pain Serious side effects: |
| infliximab-dyyb | Inflectra, a biosimilar to Remicade | • Do not take this medicine if you have moderate to severe heart failure. • Tell your doctor if you have had tuberculosis or hepatitis. | • Diarrhea • Headache • Fatigue • Nausea • Rash at the IV site • Upper respiratory infections • Urinary tract infections • Tuberculosis • Sepsis • Fungal infections |
| golimumab | Simponi Simponi Aria | •Tell your doctor if you have any infections or health conditions, like heart disease, MS, or diabetes • Get tested for TB before starting treatment. • Do not take live vaccines. • See your doctor right away if you have signs of an infection while taking this drug. | • Redness where you got the shot Rare complications:
|
| certolizumab pegol | Cimzia | • Tell your doctor if you have an infection or are being treated for an infection, or if you have diabetes, HIV, hepatitis B, cancer, or TB. | • Nerve problems such as MS • Allergic reactions • Autoimmune problems like lupus • Reactivation of hepatitis B • Serious infections, like TB, and infections from bacteria, viruses, or fungi |
| tocilizumab | Actemra | • Tell your doctor if you have a serious infection, history of gastrointestinal perforation, or if you are pregnant or plan on becoming pregnant. • Do not take live vaccines. | • Upper respiratory tract infection • Inflammation of the nose or throat • High blood pressure • Headache • Abnormal liver enzyme level • Increased risk of serious infections, like TB, and infections from bacteria, viruses, or fungi |
| sarilumab | Kevzara | • Tell your doctor if you: • Have had TB, or if your immune system is weakened by conditions such as diabetes, hepatitis, or HIV | • Upper respiratory tract infection • Urinary tract infection • Nasal congestion • Sore throat • Runny nose • Redness where you got the shot |
Rheumatoid Arthritis Drugs: Steroids
They are strong anti-inflammatory drugs that can also block other immune responses. Several man-made steroids calls corticosteroids help relieve RA symptoms and may stop or slow joint damage. You receive these RA drugs by pill or as a shot.
Because of the risk of side effects, it is generally recommended that you use these RA drugs only for brief periods; for example, when your disease flares up or until DMARDs are fully effective. If your side effects are severe, don't stop taking the drug suddenly. Talk first with your doctor about what to do.
Examples of corticosteroids:
| Name | Brand Name(s) | Precautions | Potential Side Effects |
betamethasone injectable | Celestone | Tell your doctor if you have: • Fungal infection • History of TB • Underactive thyroid • Diabetes • Stomach ulcer • High blood pressure • Osteoporosis | • Bruising • Cataracts • Increased cholesterol • Atherosclerosis • High blood pressure • Increased appetite or indigestion • Mood swings or nervousness • Muscle weakness • Osteoporosis • Infections |
| prednisone | Rayos | Tell your doctor if you have: • Fungal infection • History of TB • Underactive thyroid • Diabetes • Stomach ulcer • High blood pressure • Osteoporosis | • Bruising • Cataracts • Increased cholesterol • Atherosclerosis • High blood pressure • Increased appetite or indigestion • Mood swings or nervousness • Muscle weakness • Osteoporosis • Infections |
| methylprednisolone | Medrol | Tell your doctor if you have: • Skin rash | • Upset stomach • Stomach irritation • Vomiting • Headache • Trouble sleeping • Depression • Anxiety • Hair growth • Bruising • Skipped or irregular periods |
Rheumatoid Arthritis Drugs: NSAIDs
NSAIDs work by blocking an enzyme that promotes inflammation. By reducing inflammation, NSAIDS help reduce swelling and pain. But they are not effective in reducing joint damage. These drugs alone are not effective in treating the disease. They should be taken along with other rheumatoid arthritis medications.
As with glucocorticoids, you should use them for brief periods – they can cause severe digestive tract problems. Which type, if any, your doctor prescribes may depend on your medical history. If you have a history of stomach ulcers or liver, kidney, or heart problems, it's best to not take these drugs. Ask your doctor if any new NSAIDs with fewer side effects are available.
Examples of NSAIDs:
| Name | Brand Name(s) | Precautions | Potential Side Effects |
| celecoxib | Celebrex | • Tell your doctor if you have had a heart attack, stroke, angina, blood clot, or high blood pressure or if you have sensitivity to NSAIDs or sulfa drugs. • Do not take with other NSAIDs. • Do not take late in pregnancy. | • Increased risk of heart attack and stroke • Indigestion, diarrhea, and stomach pain • Serious skin reactions |
| diclofenac sodium | Voltaren | Tell your doctor if you: Do not take with other NSAIDs. | • Belly cramps, diarrhea • Dizziness or drowsiness • Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding • Increased risk of blood clots, heart attacks, and stroke • Greater risk of complications for people with cardiovascular disease |
| ibuprofen | Advil, Motrin | Tell your doctor if you: • Drink alcohol • Use blood thinners • Take ACE inhibitors, lithium, warfarin, or furosemide • Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers • Do not take with other NSAIDs. | • Higher risk of heart attack and stroke • Belly cramps, diarrhea • Dizziness or drowsiness • Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding • Increased risk of blood clots, heart attacks, and stroke • Greater risk of complications for people with cardiovascular disease |
Rheumatoid Arthritis Drugs: Analgesics
Analgesics reduce pain, but they do not reduce swelling or joint damage.
There are a variety of over-the-counter and prescription analgesics. Narcotics are the most powerful type of analgesic. Use these carefully, and be sure to let your doctor know if you have any history of alcoholism or drug abuse.
Examples of analgesics:
| Name | Brand Name(s) | Precautions | Potential Side Effects |
| acetaminophen | Tylenol, Feverall | • Tell your doctor if you have three or more drinks of alcohol daily. • Avoid taking more than one product with acetaminophen. | Side effects uncommon if taken as directed. |
| tramadol | Ultram | • Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants, or narcotic pain medications or if you have a history of drug or alcohol abuse. • Do not stop suddenly or increase the dose on your own. • Do not drive or use heavy machinery until you know how your body reacts to the drug. | • Constipation • Diarrhea • Drowsiness • Increased sweating • Loss of appetite • Nausea |
| oxycodone, hydrocodone, and other narcotics | OxyContin, Roxicodone | • Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants or narcotic pain medications or if you have a history of drug or alcohol abuse. • Never chew or cut tablets; a high dose can be fatal if released rapidly. | • Constipation • Dizziness • Drowsiness • Dry mouth • Headache • Increased sweating • Itchy skin • Nausea or vomiting • Shortness of breath |