Merck Manual

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Drugs Used to Treat Rheumatoid Arthritis

Drugs Used to Treat Rheumatoid Arthritis

Drug

Some Side Effects

Comments

Diclofenac

Ibuprofen

Naproxen

Many others

Upset stomach

Increased blood pressure

Kidney problems

Possibly increased risk of heart attack and stroke

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

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

Neutropeniaa

Mouth sores

Decreased sperm numbers and fertility in men

Hair loss

Sulfasalazine

Stomach problems

Neutropeniaa

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

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

Azathioprine

Cyclosporine

Liver disease

Increased risk of cancer (such as lymphoma and nonmelanoma skin cancers)

Neutropeniaa

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.

Adalimumabb

Certolizumab pegolb

Etanerceptb

Golimumabb

Infliximabb

Potential risk of reactivation of infection (particularly tuberculosis and fungal infections)

Skin cancers other than melanoma

Reactivation of hepatitis B

Demyelinating neurologic disorders (such as Guillain-Barré syndrome or multiple sclerosis)

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.

Abataceptc

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).

Anakinrad

Pain, redness, and itching at injection site

Increased risk of infection

Neutropeniaa

Anakinra is probably less effective than adalimumab, etanercept, and infliximab.

It is given by injection under the skin (subcutaneously).

Baricitinibe

Risk of infection, particularly reactivation of chickenpox and shingles

Nonmelanoma skin cancer

High cholesterol levels (hypercholesterolemia)

Baricitinib is taken by mouth.

Rituximabc

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

  • Neutropeniaa

  • 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).

Sarilumabf

Neutropeniaa (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).

Tocilizumabf

Infection (such as tuberculosis) may be serious or lead to sepsis

Neutropeniaa

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 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).

Tofacitinibe

Risk of infection, particularly reactivation of chickenpox and shingles

Nonmelanoma skin cancer

High cholesterol levels (hypercholesterolemia)

Tofacitinib is used when methotrexate has not been effective enough.

It is taken by mouth.

Upadacitinibe

Risk of infection, particularly reactivation of chickenpox and shingles

Nonmelanoma skin cancer

High cholesterol levels (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.

f Sarilumab and tocilizumab are interleukin-6 receptor blockers.