Drug | Some Side Effects | Comments |
---|---|---|
Diclofenac Ibuprofen Naproxen Many others | Upset stomach Stomach ulcers and bleeding Peptic Ulcer Disease A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. Peptic ulcers can result from infection with Helicobacter... read more Increased blood pressure Kidney problems Possible increased risk of heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more and stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more Possible increased risk of bruising and bleeding | NSAIDs treat some symptoms and decrease inflammation but do not prevent damage or alter the course of the disease. They are used less frequently now than in the past. These drugs are taken by mouth. Some NSAIDs are in cream form and can be applied to the skin directly over painful joints. |
Cyclooxygenase-2 (COX-2) inhibitors (coxibs), such as celecoxib | Kidney problems Increased blood pressure Slightly less risk of stomach ulcer and bleeding than with other NSAIDs Possible increased risk of heart attack and stroke | |
Hydroxychloroquine | Usually mild dermatitis (rash) and skin discoloration Muscle aches or weakness Rarely, cardiomyopathy Eye problems | All DMARDs can slow progression of joint damage as well as gradually decrease pain and swelling. Leflunomide is about as effective as methotrexate. These drugs are taken by mouth. Methotrexate may be given by mouth or injection under the skin (subcutaneously). |
Leflunomide | Rashes Liver disease Damage to nerves (neuropathy) Diarrhea Hair loss Birth defects | |
Methotrexate | Liver disease Lung inflammation Nausea Neutropenia* Mouth sores Decreased sperm numbers and fertility in men Hair loss Birth defects and increased risk of miscarriage | |
Sulfasalazine | Stomach problems Neutropenia* (usually only when treatment begins) Breakdown of red blood cells (hemolysis) Liver problems Rashes | |
Prednisone Prednisolone | Numerous side effects throughout the body with long-term use:
| Prednisone and prednisolone can reduce inflammation quickly. They may not be useful long term because of side effects. These drugs are usually taken by mouth but can be injected into a muscle (intramuscularly) or a vein (intravenously). |
Methylprednisolone acetate | Rarely infection at the injection sites or within the joint Weakening of tissues if injections are given too frequently for too long Rarely, bleeding into the joint after injection, particularly in people taking anticoagulants (blood thinners) | These drugs are given by injection into a joint. |
Triamcinolone acetonide | ||
Triamcinolone hexacetonide | ||
Adalimumab Certolizumab pegol Etanercept Golimumab Infliximab | Potential risk of reactivation of infection (particularly tuberculosis Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more and fungal infections Overview of Fungal Infections Fungi are living organisms, but they are not plants or animals. All living things are divided into categories called kingdoms, and fungi have their own kingdom. Some fungi cause infections in... read more ) Skin cancers other than melanoma Reactivation of hepatitis B Hepatitis B, Chronic Chronic hepatitis B is inflammation of the liver that is caused by the hepatitis B virus and that has lasted more than 6 months. Most people with chronic hepatitis B have no symptoms, but some... read more Occasionally systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more Demyelinating neurologic disorders (such as Guillain-Barré syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is a form of polyneuropathy causing muscle weakness, which usually worsens over a few days to weeks, then slowly improves or returns to normal on its own. With treatment... read more or multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more ) | These drugs are tumor necrosis factor (TNF) inhibitors. These drugs produce a dramatic, prompt response in most people. They can slow joint damage. Adalimumab, certolizumab pegol, etanercept, and golimumab are given by injection under the skin (subcutaneously). Infliximab is given as a series of infusions into a vein. |
Abatacept | Lung problems Increased susceptibility to infection Headache Upper respiratory infection Sore throat Nausea | Abatacept is a selective T cell costimulation modulator. It may be given by vein (intravenously) or by injection under the skin (subcutaneously). |
Anakinra | Pain, redness, and itching at injection site Increased risk of infection Neutropenia* | Anakinra is an interleukin-1 receptor blocker. Anakinra is probably less effective than adalimumab, etanercept, and infliximab. It is given by injection under the skin (subcutaneously). |
Rituximab | When the drug is being given:
After the drug is given:
| Rituximab is a CD20-directed cytolytic antibody that decreases the number of B-cell lymphocytes. Rituximab is used only when people do not improve after taking a tumor necrosis factor inhibitor and methotrexate. It is given by vein (intravenously). |
Sarilumab | Neutropenia* (too few infection-fighting white blood cells) Suppression of platelet production in the bone marrow, sometimes with increased susceptibility to bleeding Increase of liver enzymes | Sarilumab is an interleukin-6 (IL-6) receptor blocker. Sarilumab is given by injection under the skin (subcutaneously). |
Tocilizumab | Infection (such as tuberculosis) may be serious or lead to sepsis Neutropenia* Possibly suppression of platelet production in the bone marrow, sometimes with increased susceptibility to bleeding Anaphylaxis Anaphylactic Reactions Anaphylactic reactions are sudden, widespread, potentially severe and life-threatening allergic reactions. Anaphylactic reactions often begin with a feeling of uneasiness, followed by tingling... read more Increase of liver enzymes Rarely perforation of the intestine | Tocilizumab is an interleukin-6 (IL-6) receptor blocker. Tocilizumab is used only when people do not improve after taking other drugs. It may be given by vein (intravenously) or by injection under the skin (subcutaneously). |
Janus kinase (JAK) inhibitors | ||
Tofacitinib | Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels Dyslipidemia Dyslipidemia is a high level of cholesterol and/or triglycerides or a low level of high-density lipoprotein (HDL) cholesterol. Lifestyle, genetics, disorders (such as low thyroid hormone levels... read more (hypercholesterolemia) Major cardiovascular events (for example, heart attack, stroke) Lung cancer | Tofacitinib is used when methotrexate has not been effective enough. It is taken by mouth. |
Baricitinib | Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels Dyslipidemia Dyslipidemia is a high level of cholesterol and/or triglycerides or a low level of high-density lipoprotein (HDL) cholesterol. Lifestyle, genetics, disorders (such as low thyroid hormone levels... read more (hypercholesterolemia) Deep vein thrombosis Deep Vein Thrombosis (DVT) Deep vein thrombosis is the formation of blood clots (thrombi) in the deep veins, usually in the legs. Blood clots may form in veins if the vein is injured, a disorder causes the blood to clot... read more (DVT) Major cardiovascular events (for example, heart attack, stroke) Lung cancer | Baricitinib is taken by mouth. |
Upadacitinib | Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels Dyslipidemia Dyslipidemia is a high level of cholesterol and/or triglycerides or a low level of high-density lipoprotein (HDL) cholesterol. Lifestyle, genetics, disorders (such as low thyroid hormone levels... read more (hypercholesterolemia) Venous thromboembolism Major cardiovascular events (for example, heart attack, stroke) Lung cancer | Upadacitinib is used when methotrexate has not been effective enough. It is taken by mouth. |
* Suppression of blood cell production in the bone marrow can lead to decreased numbers of infection-fighting white blood cells called neutrophils, increasing susceptibility to infection. |