Medications Used to Treat Rheumatoid Arthritis

Medication	Some Side Effects
Conventional synthetic disease-modifying antirheumatic drugs (DMARDs)
HydroxychloroquineHydroxychloroquine	Usually mild dermatitis (rash) and skin discoloration (may be sensitive to sunlight) Muscle aches or weakness Rarely, cardiomyopathy Eye problems
LeflunomideLeflunomide	Rashes Liver disease Damage to nerves (neuropathy) Diarrhea Hair loss Birth defects
MethotrexateMethotrexate	Liver disease Lung inflammation Nausea Neutropenia* Mouth sores Decreased sperm numbers and fertility in men Hair loss Birth defects and increased risk of miscarriage
SulfasalazineSulfasalazine	Stomach problems Neutropenia* (usually only when treatment begins) Breakdown of red blood cells (hemolysis) Liver problems Rashes
Janus kinase (JAK) inhibitors
TofacitinibTofacitinib BaricitinibBaricitinib UpadacitinibUpadacitinib	Risk of infection, particularly reactivation of chickenpox and shingles Skin cancers other than melanoma High cholesterol levels (hypercholesterolemia) Major cardiovascular events (for example, heart attack, stroke) Lung cancer Venous thromboembolism (for example, deep vein thrombosis, pulmonary embolism)
Biologic DMARDs
AdalimumabAdalimumab Certolizumab pegolCertolizumab pegol EtanerceptEtanercept GolimumabGolimumab InfliximabInfliximab	Potential risk of reactivation of latent infection (particularly tuberculosis, hepatitis B, and fungal infections) Skin cancers other than melanoma Occasionally systemic lupus erythematosus Demyelinating neurologic disorders (such as Guillain-Barré syndrome or multiple sclerosis) Heart failure worsening
AbataceptAbatacept	Lung problems Increased susceptibility to infection Headache Upper respiratory infection Sore throat Nausea
AnakinraAnakinra	Pain, redness, and itching at injection site Increased risk of infection Neutropenia*
RituximabRituximab	When the medication is being given: Itching at injection site Rashes Back pain High or low blood pressure Fever After the medication is given: Slightly increased risk of certain infections and possibly cancer Neutropenia* Reactivation of hepatitis B Rarely, progressive multifocal leukoencephalopathy
TocilizumabTocilizumab SarilumabSarilumab	Neutropenia* (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 Anaphylaxis Rarely perforation of the intestine Dyslipidemia (particularly elevated low-density lipoproteins [LDL])
Corticosteroids
PrednisonePrednisone PrednisolonePrednisolone	Numerous side effects throughout the body with long-term use: Weight gain Diabetes High blood pressure Thinning of bones (osteoporosis) Death of bone due to poor blood supply (avascular necrosis) Cataracts Candidiasis, a fungal infection (oral or vaginal)
Corticosteroids, intra-articular injections
Methylprednisolone acetateMethylprednisolone acetate Triamcinolone acetonideTriamcinolone acetonide Triamcinolone hexacetonideTriamcinolone hexacetonide	Rarely infection at the injection site or within the joint Weakening and discoloration of the skin at injection site
Nonsteroidal anti-inflammatory drugs (NSAIDs)
DiclofenacDiclofenac IbuprofenIbuprofen NaproxenNaproxen Many others	Upset stomach Stomach ulcers and bleeding Increased blood pressure Kidney problems Possible increased risk of heart attack and stroke Possible increased risk of bruising and bleeding
Cyclooxygenase-2 (COX-2) inhibitors (coxibs), such as celecoxibCyclooxygenase-2 (COX-2) inhibitors (coxibs), such as celecoxib	Kidney problems Increased blood pressure Slightly less risk of stomach ulcer and bleeding than with other NSAIDs Possible increased risk of heart attack and stroke
* 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.

Medication

Some Side Effects

Conventional synthetic disease-modifying antirheumatic drugs (DMARDs)

HydroxychloroquineHydroxychloroquine

Usually mild dermatitis (rash) and skin discoloration (may be sensitive to sunlight)

Muscle aches or weakness

Rarely, cardiomyopathy

Eye problems

LeflunomideLeflunomide

Rashes

Liver disease

Damage to nerves (neuropathy)

Diarrhea

Hair loss

Birth defects

MethotrexateMethotrexate

Liver disease

Lung inflammation

Nausea

Neutropenia*

Mouth sores

Decreased sperm numbers and fertility in men

Hair loss

Birth defects and increased risk of miscarriage

SulfasalazineSulfasalazine

Stomach problems

Neutropenia* (usually only when treatment begins)

Breakdown of red blood cells (hemolysis)

Liver problems

Rashes

Janus kinase (JAK) inhibitors

TofacitinibTofacitinib

BaricitinibBaricitinib

UpadacitinibUpadacitinib

Risk of infection, particularly reactivation of chickenpox and shingles

Skin cancers other than melanoma

High cholesterol levels (hypercholesterolemia)

Major cardiovascular events (for example, heart attack, stroke)

Lung cancer

Venous thromboembolism (for example, deep vein thrombosis, pulmonary embolism)

Biologic DMARDs

AdalimumabAdalimumab

Certolizumab pegolCertolizumab pegol

EtanerceptEtanercept

GolimumabGolimumab

InfliximabInfliximab

Potential risk of reactivation of latent infection (particularly tuberculosis, hepatitis B, and fungal infections)

Skin cancers other than melanoma

Occasionally systemic lupus erythematosus

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

Heart failure worsening

AbataceptAbatacept

Lung problems

Increased susceptibility to infection

Headache

Upper respiratory infection

Sore throat

Nausea

AnakinraAnakinra

Pain, redness, and itching at injection site

Increased risk of infection

Neutropenia*

RituximabRituximab

When the medication is being given:

Itching at injection site
Rashes
Back pain
High or low blood pressure
Fever

After the medication is given:

Slightly increased risk of certain infections and possibly cancer
Neutropenia*
Reactivation of hepatitis B
Rarely, progressive multifocal leukoencephalopathy

TocilizumabTocilizumab

SarilumabSarilumab

Neutropenia* (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

Anaphylaxis

Rarely perforation of the intestine

Dyslipidemia (particularly elevated low-density lipoproteins [LDL])

Corticosteroids

PrednisonePrednisone

PrednisolonePrednisolone

Numerous side effects throughout the body with long-term use:

Weight gain
Diabetes
High blood pressure
Thinning of bones (osteoporosis)
Death of bone due to poor blood supply (avascular necrosis)
Cataracts
Candidiasis, a fungal infection (oral or vaginal)

Corticosteroids, intra-articular injections

Methylprednisolone acetateMethylprednisolone acetate

Triamcinolone acetonideTriamcinolone acetonide

Triamcinolone hexacetonideTriamcinolone hexacetonide

Rarely infection at the injection site or within the joint

Weakening and discoloration of the skin at injection site

Nonsteroidal anti-inflammatory drugs (NSAIDs)

DiclofenacDiclofenac

IbuprofenIbuprofen

NaproxenNaproxen

Many others

Upset stomach

Stomach ulcers and bleeding

Increased blood pressure

Kidney problems

Possible increased risk of heart attack and stroke

Possible increased risk of bruising and bleeding

Cyclooxygenase-2 (COX-2) inhibitors (coxibs), such as celecoxibCyclooxygenase-2 (COX-2) inhibitors (coxibs), such as celecoxib

Kidney problems

Increased blood pressure

Slightly less risk of stomach ulcer and bleeding than with other NSAIDs

Possible increased risk of heart attack and stroke

* 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.

In these topics

Rheumatoid Arthritis (RA)