Merck Manual

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Medications Used to Treat Rheumatoid Arthritis

Medications Used to Treat Rheumatoid Arthritis

Drug

Some Side Effects

Comments

Diclofenac

Ibuprofen

Naproxen

Many others

Upset stomach

Increased blood pressure

Kidney problems

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

Skin cancers other than melanoma

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:

  • 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*

  • Reactivation of hepatitis B

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

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

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

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

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.