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Medications Used to Treat Rheumatoid Arthritis

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Medication	Adverse Effects
Conventional synthetic disease-modifying antirheumatic drugs (DMARDs)
Hydroxychloroquine	Dermatitis, may be photosensitive Rarely, myopathy or cardiomyopathy Corneal opacity (generally reversible) Rarely, irreversible retinal degeneration
Leflunomide	Skin reactions Hepatic dysfunction Alopecia Diarrhea Peripheral neuropathy Teratogenicity
Methotrexate	Liver fibrosis (dose-related, often reversible) Nausea Malaise Bone marrow suppression Stomatitis Rarely, pneumonitis Teratogenicity, abortifacient effect
Sulfasalazine*	Bone marrow suppression Gastric symptoms Neutropenia (usually on initiation of treatment) Hemolysis Hepatitis Reversible oligospermia
Corticosteroids, intra-articular injections
Methylprednisolone acetate Triamcinolone acetonide Triamcinolone hexacetonide	Rarely infection at the injection site Local skin hypopigmentation or atrophy
Corticosteroids, systemic
Prednisone Prednisolone	With long-term use: Weight gain Diabetes Hypertension Osteoporosis, osteonecrosis Cataracts Candidiasis
Biologic agents
Abatacept	Pulmonary toxicity Susceptibility to infection Headache Upper respiratory infection Sore throat Nausea
Rituximab	During administration: Mild itching at the injection site Rashes Back pain Hypertension or hypotension Fever After administration: Increased risk of infection and possibly cancer Hypogammaglobulinemia Neutropenia Reactivation of hepatitis B with hepatic necrosis Rarely, progressive multifocal leukoencephalopathy
Interleukin-6 (IL-6) inhibitors‡
Tocilizumab Sarilumab	Potential risk of infection (particularly opportunistic organisms) Neutropenia Thrombocytopenia Gastrointestinal perforation Anaphylaxis Transaminase elevation Dyslipidemia (particularly elevated low-density lipoproteins [LDL])
Interleukin-1 (IL-1) receptor inhibitor‡
Anakinra	Injection site reactions Risk of infection Neutropenia
Tumor necrosis factor (TNF) inhibitors‡
Adalimumab Certolizumab pegol Etanercept Golimumab Infliximab	Potential risk of reactivation of latent infection (particularly tuberculosis, hepatitis B, and fungal infections) Nonmelanoma skin cancers Antinuclear antibodies with or without clinical systemic lupus erythematosus (SLE) Demyelinating neurologic disorders Heart failure worsening
Janus kinase (JAK) inhibitors
Baricitinib Tofacitinib Upadacitinib	Risk of infection, particularly varicella-zoster virus reactivation Nonmelanoma skin cancers Hypercholesterolemia Venous thromboembolism Major adverse cardiovascular events Lung cancer
* Sulfasalazine is usually given as enteric-coated tablets. † During dosage increases for azathioprine, complete blood count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) are monitored. ‡ These medications are biologic disease-modifying antirheumatic drugs (DMARDs). § These medications are targeted synthetic DMARDs.