Table: Drugs Used to Treat Rheumatoid Arthritis - Merck Manuals Consumer Version

Drugs Used to Treat Rheumatoid Arthritis

Drug	Some Side Effects
Nonsteroidal anti-inflammatory drugs (NSAIDs) Nonsteroidal Anti-Inflammatory Drugs In some cases, treating the underlying disorder eliminates or minimizes the pain. For example, setting a broken bone in a cast or giving antibiotics for an infected joint helps reduce pain.... read more
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 Helicobacter pylori... read more Increased blood pressure Kidney problems Possibly 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 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) and symptoms that... read more	All NSAIDs treat the symptoms and decrease inflammation but do not alter the course of the disease. 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 Less risk of stomach ulcer and bleeding than with other NSAIDs Possible increased risk of heart attack and stroke Possible increased risk of bruising and bleeding
Disease-modifying antirheumatic drugs (DMARDs) Disease-modifying antirheumatic drugs (DMARDs) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more
Hydroxychloroquine	Usually mild dermatitis (rash) Muscle aches or weakness 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 injection under the skin (subcutaneously).
Leflunomide	Rashes Liver disease Damage to nerves (neuropathy) Diarrhea Hair loss
Methotrexate	Liver disease Lung inflammation Nausea Neutropenia^a Mouth sores Decreased sperm numbers and fertility in men Hair loss
Sulfasalazine	Stomach problems Neutropenia^a Breakdown of red blood cells (hemolysis) Liver problems Rashes
Corticosteroids Corticosteroids Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more
Prednisone Prednisolone	Numerous side effects throughout the body with long-term use: Weight gain Diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more High blood pressure High Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more Thinning of bones (osteoporosis Osteoporosis Osteoporosis is a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) likely. Aging, estrogen deficiency, low vitamin D or calcium intake, and... read more ) Cataracts Cataract A cataract is a clouding (opacity) of the lens of the eye that causes a progressive, painless loss of vision. Vision may be blurred, contrast may be lost, and halos may be visible around lights... read more	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 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
Immunosuppressive drugs Immunosuppressive drugs Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more
Azathioprine Cyclosporine	Liver disease Increased risk of cancer (such as lymphoma Overview of Lymphoma Lymphomas are cancers of lymphocytes, which reside in the lymphatic system and in blood-forming organs. Lymphomas are cancers of a specific type of white blood cells known as lymphocytes. These... read more and nonmelanoma skin cancers) Neutropenia^a Cyclosporine: Impaired kidney function, high blood pressure, diabetes	Azathioprine is about as effective as some DMARDs but is more toxic. Cyclosporine is about as effective as some DMARDs but has a higher risk of side effects. These drugs are taken by mouth.
Biologic agents Biologic agents Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more
Adalimumab^b Certolizumab pegol^b Etanercept^b Golimumab^b Infliximab^b	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. Tuberculosis is spread mainly when people breathe... read more and fungal infections Overview of Fungal Infections Fungi are neither plants nor animals. They were once thought to be plants but are now classified as their own kingdom. Some fungi cause infections in people. Because fungal spores are often... 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 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^c	Lung problems Increased susceptibility to infection Headache Upper respiratory infection Sore throat Nausea	Abatacept 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).
Anakinra^d	Pain, redness, and itching at injection site Increased risk of infection Neutropenia^a	Anakinra is probably less effective than adalimumab, etanercept, and infliximab. It is given by injection under the skin (subcutaneously).
Baricitinib^e	Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels Dyslipidemia Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone... 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)	Baricitinib is taken by mouth.
Rituximab^c	When the drug is being given: Itching at injection site Rashes Back pain High or low blood pressure Fever After the drug is given: Slightly increased risk of certain infections and possibly cancer Neutropenia^a Reactivation of hepatitis B	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^f	Neutropenia^a (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 given by injection under the skin (subcutaneously).
Tocilizumab^f	Infection (such as tuberculosis) may be serious or lead to sepsis Neutropenia^a 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 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).
Tofacitinib^e	Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels Dyslipidemia Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone... read more (hypercholesterolemia)	Tofacitinib is used when methotrexate has not been effective enough. It is taken by mouth.
Upadacitinib^e	Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels Dyslipidemia Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone... read more (hypercholesterolemia) Venous thromboembolism	Upadacitinib is used when methotrexate has not been effective enough. It is taken by mouth.
^a 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.
^b Adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab are tumor necrosis factor (TNF) inhibitors.
^c Abatacept and rituximab are other types of biologic agents.
^d Anakinra is an interleukin-1 receptor blocker.
^e Baricitinib, tofacitinib, and upadacitinib are Janus kinase (JAK) inhibitors.
^fSarilumab and tocilizumab are interleukin-6 receptor blockers.