Medications Used to Treat Rheumatoid Arthritis
Medication | Adverse Effects |
|---|---|
Conventional synthetic disease-modifying antirheumatic drugs (DMARDs) | |
HydroxychloroquineHydroxychloroquine | Dermatitis, may be photosensitive Rarely, myopathy or cardiomyopathy Corneal opacity (generally reversible) Rarely, irreversible retinal degeneration |
LeflunomideLeflunomide | Skin reactions Hepatic dysfunction Alopecia Diarrhea Peripheral neuropathy Teratogenicity |
MethotrexateMethotrexate | Liver fibrosis (dose-related, often reversible) Nausea Malaise Bone marrow suppression Stomatitis Rarely, pneumonitis Teratogenicity, abortifacient effect |
Sulfasalazine*Sulfasalazine* | Bone marrow suppression Gastric symptoms Neutropenia (usually on initiation of treatment) Hemolysis Hepatitis Reversible oligospermia |
Corticosteroids, intra-articular injections | |
Methylprednisolone acetateMethylprednisolone acetate Triamcinolone acetonideTriamcinolone acetonide Triamcinolone hexacetonideTriamcinolone hexacetonide | Rarely infection at the injection site Local skin hypopigmentation or atrophy |
Corticosteroids, systemic | |
PrednisonePrednisone PrednisolonePrednisolone | With long-term use:
|
Biologic agents | |
AbataceptAbatacept | Pulmonary toxicity Susceptibility to infection Headache Upper respiratory infection Sore throat Nausea |
RituximabRituximab | During administration:
After administration:
|
Interleukin-6 (IL-6) inhibitors‡ | |
Tocilizumab Tocilizumab SarilumabSarilumab | 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‡ | |
AnakinraAnakinra | Injection site reactions Risk of infection Neutropenia |
Tumor necrosis factor (TNF) inhibitors‡ | |
AdalimumabAdalimumab Certolizumab pegolCertolizumab pegol EtanerceptEtanercept GolimumabGolimumab InfliximabInfliximab | 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 | |
BaricitinibBaricitinib TofacitinibTofacitinib Upadacitinib 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.* 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.† 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. | |