Drugs Used to Treat Rheumatoid Arthritis
Drug |
Some Side Effects |
Comments |
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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. |
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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 |
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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). |
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Leflunomide |
Rashes Liver disease Damage to nerves (neuropathy) Diarrhea Hair loss |
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Methotrexate |
Liver disease Lung inflammation Nausea Neutropeniaa Mouth sores Decreased sperm numbers and fertility in men Hair loss |
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Sulfasalazine |
Stomach problems Neutropeniaa Breakdown of red blood cells (hemolysis) Liver problems Rashes |
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Prednisone Prednisolone |
Numerous side effects throughout the body with long-term use:
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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). |
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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. |
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Triamcinolone acetonide |
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Triamcinolone hexacetonide |
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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. |
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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 Occasionally systemic lupus erythematosus 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. |
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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). |
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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). |
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Baricitinibe |
Risk of infection, particularly reactivation of chickenpox and shingles Nonmelanoma skin cancer High cholesterol levels (hypercholesterolemia) Deep vein thrombosis (DVT) |
Baricitinib is taken by mouth. |
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Rituximabc |
When the drug is being given: After the drug is given: |
Rituximab is used only when people do not improve after taking a tumor necrosis factor inhibitor and methotrexate. It is given by vein (intravenously). |
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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). |
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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). |
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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. |
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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. |
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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. |
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b Adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab are tumor necrosis factor (TNF) inhibitors. |
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c Abatacept and rituximab are other types of biologic agents. |
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d Anakinra is an interleukin-1 receptor blocker. |
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e Baricitinib, tofacitinib, and upadacitinib are Janus kinase (JAK) inhibitors. |
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f Sarilumab and tocilizumab are interleukin-6 receptor blockers. |
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