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Even if your rheumatoid arthritis (RA) is mild, the sooner you start treatment, the better. One of the key goals is to tame inflammation.

Almost everyone with rheumatoid arthritis takes medicine for it. But there are different kinds.

Some drugs help control the disease and limit joint damage. Others ease pain and inflammation but don’t curb joint damage. You may take more than one type of drug. If your joint damage is severe, you may need joint replacement or other surgeries. Use this guide to get to know what your doctor may recommend.

The First Drugs Your Doctor Will Probably Prescribe: DMARDs

Examples: These medications include hydroxychloroquine, leflunomide, methotrexate, and sulfasalazine. Your doctor will call them “DMARDs,” which stands for “disease-modifying anti-rheumatic drug.” Anyone diagnosed with RA should start taking at least one DMARD immediately, usually methotrexate, no matter how mild their disease.

Tofacitinib (Xeljanz) is different, because unlike other DMARDs, it affects a specific part of the immune system involved in RA. It also makes you more likely to get a serious infection. Your doctor may try it or another drug if methotrexate doesn’t work.  

What they do: They work in different ways to curb the immune system.

How you take them: You can take them as a pill, although some people get methotrexate as an injection. It may take from 4 to 6 weeks to a few months for them to start to work, and longer to reach their full effect.

Side effects: These vary with each medicine. Serious risks include infection and kidney or liver damage. Methotrexate and leflunomide can cause birth defects. If you’re a woman planning to get pregnant, talk with your doctor first.

Biologic Drugs

Examples: abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), and tocilizumab (Actemra).

What they do: Biologics target specific parts of the immune system to turn down inflammation. These drugs can work quickly to reduce joint pain and swelling. Over time, they can slow down joint damage and help your joints move better. Doctors use biologics to treat moderate to severe RA that methotrexate or other DMARDs don’t control.