Which Medications Would Most Likely Help to Treat Rheumatoid Arthritis? A Comprehensive Guide

October 14, 2025 •

4 min read

According to the CDC, approximately 1.5 million Americans have rheumatoid arthritis (RA), an autoimmune disease requiring early, aggressive treatment to prevent permanent joint damage. Understanding which medications would most likely help to treat rheumatoid arthritis is crucial for controlling inflammation, managing pain, and preserving joint function. The cornerstone of RA therapy involves disease-modifying antirheumatic drugs (DMARDs), complemented by symptom-relieving agents like NSAIDs and corticosteroids.

Quick Summary

Different medication classes, including DMARDs, biologics, JAK inhibitors, NSAIDs, and corticosteroids, are used to treat rheumatoid arthritis. DMARDs are the core of treatment, slowing disease progression, while others offer symptomatic relief. The best approach is a tailored, combination therapy determined by a rheumatologist.

Key Points

DMARDs are the cornerstone of RA treatment: Disease-Modifying Antirheumatic Drugs, including conventional, biologic, and targeted synthetic types, slow the disease and prevent permanent joint damage.
Methotrexate is the standard starting point: As a conventional DMARD, methotrexate is typically the first medication prescribed due to its proven efficacy and long history of use.
Biologics offer targeted therapy: If conventional DMARDs are not enough, biologics, such as TNF inhibitors, target specific parts of the immune system to reduce inflammation.
JAK inhibitors are effective oral alternatives: These targeted synthetic DMARDs block specific enzyme pathways inside cells and are an option when other treatments fail or are not tolerated.
NSAIDs and corticosteroids provide short-term relief: These medications are used to manage immediate pain and inflammation, particularly during flares, but do not alter the long-term disease course.
Treatment plans are highly personalized: A rheumatologist designs a customized strategy using single or combination therapies based on the individual patient's disease activity, medical history, and preferences.
Regular monitoring is essential: Due to the potential for side effects, regular blood tests and monitoring are crucial for patients on long-term DMARDs and biologics.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder where the immune system mistakenly attacks healthy tissue, primarily affecting the joints. The goals of RA treatment are to alleviate symptoms, reduce inflammation, and prevent long-term joint and organ damage. This is accomplished through a strategic, personalized approach using various medications, often in combination.

The Cornerstone of RA Treatment: Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs are the foundation of rheumatoid arthritis treatment. Unlike drugs that only manage symptoms, DMARDs work by altering the underlying disease process, suppressing the overactive immune system to slow or halt its progression. It is critical to start DMARDs early in the disease course to prevent irreversible joint damage.

Conventional Synthetic DMARDs (csDMARDs)

These are often the first-line treatment and have been used for decades. They broadly suppress the immune system to reduce inflammation.

Methotrexate (Trexall, Otrexup): This is considered the standard initial DMARD for most patients due to its proven efficacy and long track record. It is typically taken once weekly, either orally or via injection. Folic acid supplementation is usually recommended to reduce side effects like nausea.
Leflunomide (Arava): A potent DMARD that can be used alone or in combination with other agents, often as an alternative to methotrexate.
Hydroxychloroquine (Plaquenil): A milder DMARD, sometimes used for less severe RA or in combination therapy.
Sulfasalazine (Azulfidine): Can be used alone or with other DMARDs.

Biologic DMARDs (bDMARDs)

If csDMARDs are not effective, a rheumatologist may introduce biologic DMARDs. These are genetically engineered proteins that target specific parts of the immune system responsible for inflammation. They are administered by injection or IV infusion.

Tumor Necrosis Factor (TNF) Inhibitors: This class blocks TNF, a protein that promotes inflammation. Examples include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), certolizumab (Cimzia), and golimumab (Simponi).
B-cell Inhibitors: These target B-cells, another type of immune cell. Rituximab (Rituxan) is an example.
Interleukin (IL) Inhibitors: These block inflammatory chemicals like IL-1 or IL-6. Tocilizumab (Actemra) and sarilumab (Kevzara) are examples.
Selective Co-stimulation Modulators: These block communication between immune cells. Abatacept (Orencia) is an example.

Targeted Synthetic DMARDs (tsDMARDs) / JAK Inhibitors

This is a newer class of oral medications used when conventional DMARDs and biologics are not sufficient. JAK inhibitors block the Janus kinase enzymes inside cells, disrupting the inflammatory signaling pathways.

Tofacitinib (Xeljanz): A pan-JAK inhibitor available orally.
Baricitinib (Olumiant): A JAK1/JAK2 inhibitor taken orally.
Upadacitinib (Rinvoq): A selective JAK1 inhibitor taken orally.

Symptom-Relieving Medications

These medications are used to reduce pain and inflammation but do not alter the disease's progression. They are often used alongside DMARDs, particularly during treatment initiation or flares.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Available over-the-counter and by prescription, NSAIDs help reduce pain and swelling. Examples include ibuprofen (Advil) and naproxen (Aleve). Higher doses may require a prescription. Long-term use carries risks of gastrointestinal issues, cardiovascular problems, and kidney damage.

Corticosteroids

Powerful anti-inflammatory drugs like prednisone are used for rapid, short-term relief during severe flare-ups. Long-term use is avoided due to serious side effects, including osteoporosis, weight gain, and increased risk of infection. They can be taken orally or injected directly into an affected joint.

Comparing Rheumatoid Arthritis Medications


Feature	csDMARDs (e.g., Methotrexate)	Biologic DMARDs (e.g., Humira)	JAK Inhibitors (e.g., Xeljanz)	NSAIDs (e.g., Ibuprofen)	Corticosteroids (e.g., Prednisone)
Mechanism	Broad immunosuppression	Targets specific immune system components (e.g., TNF)	Blocks specific enzyme pathways inside cells	Blocks enzymes that cause inflammation	Potent anti-inflammatory and immunosuppressant
Route of Admin	Oral tablets or injections	Injections or IV infusions	Oral tablets	Oral tablets, capsules	Oral tablets, injections
Onset of Action	Weeks to months	Weeks	Days to weeks	Rapid (hours)	Rapid (hours to days)
Disease Progression	Slows or stops progression	Slows or stops progression	Slows or stops progression	No effect on progression	Slows progression short-term
Primary Use	Standard first-line treatment	Second-line, for inadequate response to csDMARDs	Used after failure of other DMARDs	Short-term pain and inflammation relief	Short-term flare management

A Tailored Treatment Plan

There is no one-size-fits-all answer for which medications are best, as treatment is highly individualized. A rheumatologist will develop a "treat-to-target" strategy based on the patient's specific disease activity, overall health, and preferences. Regular monitoring through blood tests is necessary for many of these medications to watch for side effects. Combination therapy, such as a csDMARD with a biologic, often proves more effective than monotherapy. Patients should also discuss lifestyle factors, including exercise and diet, with their healthcare team to optimize outcomes.

Conclusion

For those asking which medications would most likely help to treat rheumatoid arthritis, the answer lies in a multi-pronged pharmacological approach. A treatment plan typically starts with csDMARDs like methotrexate to modify the disease course and prevent damage. For many patients, these may be combined with or replaced by more targeted biologics or JAK inhibitors if initial therapy is insufficient. Short-term symptom relief is provided by NSAIDs and corticosteroids during flares. A close working relationship with a rheumatologist is vital to navigate the options, manage potential side effects, and achieve the best possible long-term control over this autoimmune condition.

For more in-depth information and patient guidelines, the American College of Rheumatology is an excellent resource.

Frequently Asked Questions

The standard first-line medication for most patients with rheumatoid arthritis is a conventional synthetic DMARD called methotrexate, which is highly effective and has a long track record of safety.

Biologic medications are genetically engineered proteins that work by targeting specific molecules and pathways in the immune system that cause inflammation. They are used when conventional DMARDs are not effective enough.

No, NSAIDs only provide symptomatic relief from pain and inflammation. They do not slow the progression of the disease and are usually used as a temporary measure alongside DMARDs, which are needed to prevent joint damage.

JAK inhibitors are oral, synthetic medications that work by blocking enzyme pathways inside immune cells, while biologics are protein-based drugs given by injection or infusion that act on specific targets outside cells.

While effective for quick relief during flares, long-term use of corticosteroids like prednisone can cause serious side effects, including bone thinning (osteoporosis), weight gain, high blood pressure, and an increased risk of infection.

Yes, combination therapy is very common and often more effective. A rheumatologist might combine a conventional DMARD like methotrexate with a biologic or other DMARD to achieve better disease control.

DMARDs typically take weeks to months to show their full effect. Biologics can work more quickly, sometimes within a few weeks. Meanwhile, NSAIDs and corticosteroids can offer more immediate symptom relief.