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Rheumatoid Arthritis Drug Guide

Rheumatoid arthritis (RA) is a progressive inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment. 

Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. Starting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches.

You may take rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of RA medications:

  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologic response modifiers (a type of DMARD)
  • Glucocorticoids
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Analgesics (painkillers)

In the past, doctors took a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with NSAIDs such as ibuprofen. Then, they progressed to more potent RA drugs for people who showed signs of joint damage.

Today, doctors know that an aggressive approach is often more effective; it will result in fewer symptoms, better function, less joint damage, and decreased disability. The goal, if possible, is to put the disease into remission.

Rheumatoid Arthritis Drugs: DMARDs

If you've been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of DMARDs within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, DMARDs can often slow or stop the progression of RA by interrupting the immune process that promotes inflammation. However, they may take up to six months to be fully effective.

DMARDs have greatly improved the quality of life for many people with rheumatoid arthritis. These RA drugs are often used along with NSAIDs or glucocorticoids; however, with this type of medication, you may not need other anti-inflammatories or analgesics.

Because DMARDs target the immune system, they also can weaken the immune system's ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to make sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or kidneys.

Examples of DMARDs:


NameBrand Name(s)PrecautionsPotential Side Effects
(oral gold)

Limit exposure to sunlight and tell your doctor if you have had:
• Any adverse reactions to gold-containing medications
• A history of blood-cell problems
• Inflammatory bowel, kidney, or bowel disease

• Diarrhea
• Low blood counts
• Metallic taste
• Mouth ulcers

• Skin rash or itching



Tell your doctor if:
• You use allopurinol
• You have kidney or liver disease

• Fever or chills
• Loss of appetite
• Liver problems
• Low blood counts
• Nausea or vomiting
• Extreme fatigue


Azathiaprine is associated with certain cancers, such as lymphoma.


Sandimmune, Neoral

Tell your doctor if you have:
• Liver or kidney disease
• Active infection
• High blood pressure

• Headache
• High blood pressure
• Hair growth
• Kidney problems
• Loss of appetite
• Nausea

Increased risk of infection and certain cancers.
gold sodium thiomalate (injectable gold)


Tell your doctor if you have:
• Lupus
• Skin rash
• Kidney disease
• Colitis

• Irritated, sore tongue
• Irritated, bleeding gums
• Metallic taste
• Skin rash or itching
• White spots on mouth or throat

Joint pain may occur for a few days after first few injections.

hydroxychloroquine sulfatePlaquenilTell your doctor if you have vision problems; vision may be damaged with high doses or long-term use.

• Blurry vision or increased light sensitivity
• Headache
• Abdominal cramps or pain
• Loss of appetite, nausea, vomiting, or diarrhea
• Itching or rashes


Tell your doctor if you have:
• Active infection
• Liver or kidney disease
• Cancer

Stop taking leflunomide before trying to conceive.

• Dizziness
• Hair loss
• Headache
• Heartburn
• High blood pressure
• Gastrointestinal or liver problems
• Low blood cell count
• Neuropathy
• Skin rash

methotrexateRheumatrex, TrexallTell your doctor if you have:
• Abnormal blood counts
• Liver or lung disease
• Alcoholism
• Active infection or hepatitis

• Abdominal pain
• Chills or fever
• Dizziness
• Hair loss
• Headache
• Light sensitivity
• Itching
• Liver problems
• Low blood counts

Rare, but serious:

Dry cough, fever, or trouble breathing, which may result from a blood disease
tofacitinibXeljanz• Xeljanz adds to risk of serious infections, cancers, lymphoma.
• May increase cholesterol levels and liver enzymes.
• May lower blood count.
• Upper respiratory tract infection
• Headache
• Diarrhea
• Inflammation of the nasal passage and the upper part of the throat


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