Rheumatoid Arthritis: Medicines

Rheumatoid arthritis (RA) is a long-term (chronic) condition. It's also called an autoimmune disease. In RA, the body's immune system attacks the joints. It causes inflammation in the joint lining (synovium). This leads to pain, swelling, and difficulty moving. Most people also have symptoms that affect the rest of their bodies. For example, they may have fever and body aches. Over time, the joint may be damaged permanently. That is why early treatment is so important. Treatment includes medicines. It also includes:

  • Lifestyle changes. These include losing weight if you are overweight. It also includes exercise to keep your joints moving. Range of motion exercises can help.

  • Joint protection. Changing the way you do things and using assistive devices can protect your joints from damage.

  • Natural and alternative treatments. These include using heat and cold. It also includes acupuncture, biofeedback, and massage.

  • Learning to deal with RA. Relaxation techniques and counseling can help.

Many different medicines are used to treat RA. Because RA can be complicated, it's best managed by rheumatologists or specialists in arthritis, autoimmune disorders, and other conditions. The medicines that may be prescribed include the following.

Healthcare provider talking to man in exam room.

Nonsteroidal anti-inflammatory drugs (NSAIDs) 

NSAIDs help ease pain and inflammation. They are available over the counter and by prescription. Ibuprofen and naproxen sodium are common over-the counter NSAIDs. There are also several prescription NSAIDs. NSAIDs can cause stomach problems. These include bleeding and other side effects. One NSAID that is safer for the stomach is celecoxib. But it may cause other side effects. Talk with your healthcare provider before taking these medicines.

Corticosteroids

Corticosteroids or steroids are strong anti-inflammatory medicines. They can quickly control inflammation. Prednisone, prednisolone, and methylprednisolone are commonly used steroid medicines. They are used short-term because of serious side effects. Steroids can be taken by mouth (orally) or injected into affected joints. 

Traditional disease-modifying antirheumatic drugs (DMARDs)

DMARDs change the course of RA. They are often started soon after diagnosis to prevent joint damage. Using a DMARDS early on has been shown to help prevent the disease from getting worse. Methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine are commonly used traditional DMARDs.

Biologic DMARDs

Biologic agents (biologics) also change the course of RA. Each of the medicines slows inflammation and prevents damage to the joints. Several biologics are used to treat RA. Biologics may help some people with RA who haven't responded to other medicines. Traditional biologic medicines are abatacept, certolizumab, etanercept, and infliximab. Traditional biologic medicines can be given by injection under the skin (subcutaneously) or into a vein (intravenously).

Small molecule DMARDs

A new class of DMARDs that are given by mouth was introduced in 2013. There are three FDA-approved small-molecule DMARDs: tofacitinib, upadacitinib, and baricitinib. 

DMARDs and biologics

The American College of Rheumatology is made up of experts in arthritis treatment. The group has, set guidelines for using DMARDs and biologic agents. The recommendations help healthcare providers know which medicines to use, as well as how and when to make changes. And because these medicines increase the chance of serious infections, they also guide healthcare providers about when to screen for tuberculosis and what vaccines to take.

Work with your rheumatologist to find the medicines that work best for you. Your healthcare provider may try different medicines or combinations of them. To get the most benefit and lessen the chance of side effects, make sure you go to all appointments, get all recommended tests and vaccines, and carefully follow all instructions.

Online Medical Reviewer: Diane Horowitz MDMarianne Fraser MSN RNRaymond Kent Turley BSN MSN RN

Date Last Reviewed: 2/1/2023

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