Musculoskeletal

Medicines for Rheumatoid arthritis

An autoimmune condition where the immune system attacks the joint lining, causing pain, swelling and stiffness — controlled early with disease-modifying medicines to prevent lasting joint damage.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is a long-term autoimmune condition in which the immune system mistakenly attacks the lining of the joints. This causes pain, swelling and stiffness — classically in the small joints of the hands and feet, often on both sides — with stiffness that is typically worse in the morning.

  • How it is treated: The guiding principle is to start a disease-modifying medicine early and to "treat to target" — adjusting treatment until inflammation is brought under control and then keeping it there, rather than simply easing symptoms.
  • Self-care: Staying active to keep joints mobile and muscles strong, balancing exercise with rest during flares, stopping smoking (which worsens RA and reduces how well treatment works), a healthy weight and support from physiotherapy and occupational therapy all help people stay well and protect function.
  • When to seek help: New persistent joint swelling, pain and early-morning stiffness lasting more than half an hour should be assessed promptly, as early treatment protects the joints.

What it is

Rheumatoid arthritis (RA) is a long-term autoimmune condition in which the immune system mistakenly attacks the lining of the joints. This causes pain, swelling and stiffness — classically in the small joints of the hands and feet, often on both sides — with stiffness that is typically worse in the morning. Unlike wear-and-tear arthritis, RA is an active inflammatory process that, if left unchecked, can erode and deform joints and may also affect other parts of the body. It can flare and settle, and may come with tiredness and feeling generally unwell. Because the damage can be permanent and tends to happen early, prompt diagnosis and treatment matter a great deal; blood tests and imaging support the diagnosis and help track disease activity over time.

How it is treated

The guiding principle is to start a disease-modifying medicine early and to "treat to target" — adjusting treatment until inflammation is brought under control and then keeping it there, rather than simply easing symptoms. Disease-modifying anti-rheumatic drugs (DMARDs) change the course of the illness and protect the joints; methotrexate is the usual anchor, used alone or in combination. If conventional DMARDs do not control the disease, targeted treatments — biologic medicines or JAK inhibitors — are added under specialist care, after screening for infections such as tuberculosis and hepatitis and with ongoing monitoring. It is important to distinguish these disease-modifying treatments from medicines that only relieve symptoms: anti-inflammatory painkillers and short courses of steroid help comfort and settle flares but do not stop joint damage. Care is shared between the GP and a rheumatology team, with regular blood tests and activity scoring.

For this condition, these medicines

Medicine classes used for Rheumatoid arthritis

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

Methotrexate Rheumatology The anchor disease-modifying drug (DMARD); usually started early to control inflammation and protect joints. Hydroxychloroquine Rheumatology A DMARD used in milder disease or as part of a combination. Azathioprine Rheumatology A further DMARD option in selected people. Anti-TNF biologics Rheumatology Added when conventional DMARDs are not enough; needs infection screening and monitoring. JAK inhibitors Rheumatology A targeted oral option when conventional DMARDs are insufficient; needs monitoring. Rituximab Rheumatology A biologic option used in selected people whose disease is not controlled by other treatments. Systemic corticosteroids Endocrine / Immunology Used short-term to bridge until DMARDs take effect and to settle flares — not a long-term solution. NSAIDs Pain & inflammation Relieve pain and stiffness but do not change the disease course; used for symptom control only.

Symptom checker

Symptoms that can point to Rheumatoid arthritis

Rheumatoid arthritis can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

Joint painPain, stiffness or swelling in one or more joints, ranging from everyday wear-and-tear art…Knee painKnee pain is discomfort in or around the knee joint, often from wear, injury or inflammati…Shoulder painShoulder pain is discomfort in or around the shoulder joint, often from the soft tissues, …Neck painNeck pain is discomfort or stiffness in the neck, usually from muscle or joint strain, and…Heel painPain felt under or behind the heel — often sharpest on the first steps in the morning — th…Hip painPain felt in the hip joint, groin, outer thigh or buttock — most often from wear-and-tear …Foot painPain in any part of the foot — heel, arch, toes or the ball of the foot — most often from …Hand and finger painPain, aching or stiffness in the hands, fingers or thumb — most often from arthritis, a tr…Ankle painPain, stiffness or swelling in or around the ankle joint that most often comes from a spra…

Clinical formulas & tools

Calculators used in Rheumatoid arthritis

Risk scores and formulas that inform assessment and treatment decisions in this condition:

DAS28-ESRRheumatoid arthritis disease activity.DAS28-CRPRheumatoid arthritis activity (CRP version).

By active ingredient

Specific medicines used for Rheumatoid arthritis

Dose-free guides to individual active ingredients used in rheumatoid arthritis — what each is, how it works, how to take it, and its advantages and disadvantages:

CelecoxibA COX-2 selective anti-inflammatory painkiller for arthritis, gentler on the stomach than …PrednisoneAn oral steroid that damps down inflammation and the immune system — used mainly in the US…PrednisoloneThe usual oral steroid in the UK, used to reduce inflammation in many conditions — from as…MeloxicamA once-daily NSAID that eases joint pain, swelling and stiffness in arthritis, with the us…SulfasalazineA disease-modifying medicine that calms inflammation in rheumatoid arthritis and inflammat…LeflunomideA disease-modifying medicine for inflammatory arthritis that is harmful in pregnancy and n…PenicillamineAn older DMARD used for rheumatoid arthritis and to remove excess copper in Wilson's disea…TofacitinibAn oral JAK inhibitor that calms an overactive immune system in rheumatoid arthritis and s…UpadacitinibAn oral JAK inhibitor that calms an overactive immune system in rheumatoid arthritis and o…AdalimumabAn injectable anti-TNF biologic used for rheumatoid arthritis, psoriasis, inflammatory bow…EtanerceptAn injectable anti-TNF biologic used for rheumatoid arthritis, psoriasis and ankylosing sp…InfliximabAn anti-TNF biologic, usually given as an infusion, used for inflammatory arthritis and in…Certolizumab pegolAn injectable anti-TNF biologic used for rheumatoid arthritis, psoriatic arthritis, ankylo…GolimumabAn injectable anti-TNF biologic used for rheumatoid arthritis, psoriatic arthritis, ankylo…AbataceptA biologic that calms the immune system's T-cells, used mainly for rheumatoid arthritis.…TocilizumabA biologic that blocks interleukin-6 to control rheumatoid arthritis and some other inflam…SarilumabA biologic injection that blocks interleukin-6 to control rheumatoid arthritis.…BaricitinibAn oral tablet used for rheumatoid arthritis, eczema and severe hair loss that works by ca…AuranofinAn older gold-containing tablet used as a disease-modifying treatment for rheumatoid arthr…IndomethacinA strong anti-inflammatory painkiller used for gout, arthritis and other inflammatory pain…MethylprednisoloneA steroid medicine used to reduce inflammation and calm the immune system, given as tablet…ChloroquineA medicine used to prevent and treat malaria and, in some cases, to help conditions such a…SulindacAn anti-inflammatory painkiller (NSAID) used to relieve pain and inflammation, including i…FlurbiprofenAn anti-inflammatory painkiller used for pain and inflammation, also available as a sore-t…OxaprozinA long-acting anti-inflammatory painkiller used mainly for arthritis, taken once a day.…FenoprofenAn anti-inflammatory painkiller used for pain and arthritis.…DiflunisalAn anti-inflammatory painkiller, related to aspirin, used for pain and inflammation such a…SalsalateA salicylate anti-inflammatory painkiller used to ease pain and inflammation in conditions…TolmetinAn anti-inflammatory painkiller used to ease the pain, swelling and stiffness of arthritis…TriamcinoloneA steroid medicine that reduces inflammation, often given as an injection into a joint or …FilgotinibA daily tablet that calms an overactive immune system to treat rheumatoid arthritis and ul…AnakinraA daily under-the-skin injection that blocks an inflammatory signal to treat rheumatoid ar…Tiaprofenic acidAn anti-inflammatory painkiller used for pain and swelling in joint conditions, with a kno…MethotrexateA cornerstone treatment for rheumatoid arthritis and severe psoriasis that calms an overac…AzathioprineA long-term medicine that calms an overactive or transplant-rejecting immune system — used…Folic acidA B-vitamin used to prevent and treat folate-deficiency anaemia, to protect against neural…HydroxychloroquineA well-tolerated long-term treatment for rheumatoid arthritis and lupus — it calms immune …

Beyond medication

Lifestyle and self-care

Staying active to keep joints mobile and muscles strong, balancing exercise with rest during flares, stopping smoking (which worsens RA and reduces how well treatment works), a healthy weight and support from physiotherapy and occupational therapy all help people stay well and protect function.

When to get help

When to see a doctor

New persistent joint swelling, pain and early-morning stiffness lasting more than half an hour should be assessed promptly, as early treatment protects the joints. If you are on disease-modifying or biologic treatment and develop a fever, signs of infection or feel very unwell, seek medical advice without delay.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

Rheumatoid arthritis: frequently asked questions

What medicines are used for rheumatoid arthritis?

The mainstay is disease-modifying anti-rheumatic drugs (DMARDs), with methotrexate as the usual anchor, alongside options such as hydroxychloroquine and azathioprine. When these are not enough, biologic medicines (including anti-TNF treatments and rituximab) or JAK inhibitors are added under specialist care. Steroids are used short-term for flares, and anti-inflammatory painkillers (NSAIDs) for symptom relief only.

What is the difference between treating symptoms and treating the disease?

Painkillers and anti-inflammatory medicines, and short courses of steroid, make you more comfortable and settle flares, but they do not stop the underlying immune attack. Disease-modifying drugs and biologics actually slow or halt the inflammation that damages joints — which is why they are started early and continued long term.

Why do I need blood tests and infection screening?

DMARDs and biologics work by dampening the immune system, so regular blood tests check that they are not affecting the blood count, liver or kidneys. Before starting biologics or JAK inhibitors, screening for infections such as tuberculosis and hepatitis is done because these treatments can allow a dormant infection to reactivate.

Will rheumatoid arthritis damage my joints?

It can, but modern treatment has changed the outlook. Starting a disease-modifying medicine early and adjusting it until the inflammation is controlled — the "treat to target" approach — greatly reduces the risk of lasting joint damage and helps people stay active.

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Sources

Where this is drawn from

  • NICE NG100: Rheumatoid arthritis in adults: management.
  • NICE CKS: Rheumatoid arthritis.

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