Rheumatoid Arthritis Treatment: A Nurse’s Guide to RA Medications

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

Rheumatoid arthritis treatment centers on medicines called DMARDs, which calm the immune system’s attack on your joints and help prevent damage. For most people, the first medicine is methotrexate. If that is not enough, your rheumatologist may add or switch to other DMARDs, a biologic or a JAK inhibitor, adjusting the plan until your disease is under control.

There are a lot of drug names in RA care. This guide explains each group in plain words, so you can have better talks with your care team.

The Goal of Rheumatoid Arthritis Treatment

RA has no cure yet. The aim is to get the disease as quiet as possible, ideally remission, with few or no signs of active inflammation. When that is not realistic, the goal is low disease activity.

Starting early matters. Mayo Clinic notes that early treatment with DMARDs makes remission more likely. The longer inflammation goes unchecked, the more chance it has to damage your joints.

What “treat-to-target” means

The 2021 American College of Rheumatology (ACR) guideline strongly recommends an approach called treat-to-target. It works like this:

You and your doctor agree on a goal, such as remission or low disease activity.
Your doctor checks your disease activity at regular visits.
If you are not at the goal, the plan is adjusted.
This repeats until the target is reached and held.

That is why you may change medicines along the way. It does not mean you failed. It means the plan is working the way it should.

Methotrexate: Usually the First Medicine

The ACR guideline strongly recommends methotrexate alone as the first treatment for most people with moderate to high disease activity who have not tried a DMARD before.

Here is what to know, based on MedlinePlus drug information from the National Library of Medicine:

For RA, it is usually taken once a week, not once a day. This is a very important safety point. MedlinePlus warns that some people who took it daily by mistake had very severe side effects or died. Use a pill box or phone alarm, and ask your pharmacist if you are unsure.
It comes as pills or a shot. Your doctor will choose what fits you.
It takes time. Symptoms may begin to improve in 3 to 6 weeks.
Folic acid may help. Your doctor may prescribe folic acid to lower the chance of side effects.
Side effects can include headache, dizziness and hair loss. Call your doctor if you get mouth sores, vomiting, new diarrhea or a fever.
You will need regular lab tests before and during treatment to check for side effects.
Ask about alcohol. Drinking large amounts can raise the risk of liver damage.
Pregnancy: Methotrexate can harm an unborn baby. If you could become pregnant, you will need a pregnancy test before starting and birth control during treatment. Talk with your doctor well before planning a pregnancy.

Other Conventional DMARDs

Other older DMARDs may be used alone or together with methotrexate:

Hydroxychloroquine: The ACR guideline suggests it for people with mild disease.
Sulfasalazine: Sometimes used with methotrexate and hydroxychloroquine. This combination is called “triple therapy.”
Leflunomide: Another conventional DMARD your doctor may consider.

These medicines slow the disease, but they can have side effects. Mayo Clinic notes possible liver damage and severe lung infections. Regular lab work and follow-up visits help keep you safe.

Biologics

If methotrexate alone does not control your RA, your doctor may add a biologic. These medicines target specific parts of the immune system. They often work best together with methotrexate.

Common groups include:

TNF inhibitors: such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade)
Other biologics: such as abatacept (Orencia), rituximab (Rituxan) and tocilizumab (Actemra)

Biologics do not come as pills. Some are shots you give yourself at home. Others are given through an IV in a clinic.

Before you start a biologic, the Arthritis Foundation advises getting screened for tuberculosis (TB) and hepatitis B. Biologics raise the risk of infections, including TB and fungal infections.

JAK Inhibitors

JAK inhibitors are a newer group of RA pills. They include:

Tofacitinib (Xeljanz, Xeljanz XR)
Baricitinib (Olumiant)
Upadacitinib (Rinvoq)

The FDA boxed warning

In 2021, the FDA required a boxed warning, its strongest kind, on these JAK inhibitors. The warning covers a higher risk of:

Serious heart-related events, such as heart attack or stroke
Cancer, including lymphoma and lung cancer
Blood clots
Death

The FDA also limited their use to people who did not respond well to, or could not take, one or more TNF inhibitors. Tell your doctor if you smoke now or smoked in the past, or if you have had a heart attack, other heart problems, a stroke or blood clots.

Call 911 or go to the ER right away if you take a JAK inhibitor and have:

Chest pain or pressure, or chest discomfort that lasts more than a few minutes or comes back
Pain in your arms, back, neck, jaw or stomach
Shortness of breath, cold sweat, nausea or lightheadedness
Weakness on one side, slurred speech or a drooping mouth
A swollen, painful, red or discolored arm or leg

Steroids: For Short-Term Help

Corticosteroids like prednisone work fast to calm inflammation. They can be helpful for a short time, such as while waiting for a DMARD to start working.

But they are not meant for the long run. The ACR guideline strongly recommends against long-term steroid use. Mayo Clinic notes that the risk of side effects rises with high doses over a long time. These side effects include:

Bone thinning and fractures
Weight gain
Easy bruising
Diabetes
Cataracts and glaucoma

Steroids also do not prevent joint damage on their own. If you are on prednisone, do not stop it on your own. Your doctor will tell you how to lower the dose safely.

Pain Relievers

Over-the-counter NSAIDs like ibuprofen and naproxen can ease pain and swelling. They do not slow RA itself. They can also cause stomach upset, heart problems and kidney damage, so ask your doctor before using them regularly.

Infection and Vaccine Basics

Many RA medicines turn down parts of your immune system. That helps your joints, but it can make infections more likely or more serious.

Infection safety tips

Call your doctor if you have a fever, cough or other signs of infection. They may want to pause your RA medicine until you recover. Do not decide this on your own.
Wash your hands often and keep cuts clean.
Tell every provider, including your dentist and surgeon, which RA medicines you take.

Vaccines

Flu: The ACR encourages a flu shot every year.
Pneumonia and shingles: The ACR advises these vaccines for people on immune-suppressing medicines.
Live vaccines: These include vaccines for measles (MMR), chicken pox and yellow fever. They can make you sick if your immune system is turned down. The Arthritis Foundation advises against live vaccines while on biologics.
Timing with methotrexate: For people whose RA is well controlled, the ACR notes that holding methotrexate for two weeks after a flu shot may help the vaccine work better. Only do this if your rheumatology team says so.

Ask your rheumatologist before getting any vaccine.

Beyond Medicine

Medicine is the base of RA care, but other things help too:

Physical and occupational therapy can teach exercises and easier ways to do daily tasks.
Gentle activity like walking or warm-water exercise keeps joints moving and helps with fatigue.
Quitting smoking matters, because smoking makes RA worse.
Surgery may help if a joint is badly damaged.

Frequently Asked Questions

How long does it take for rheumatoid arthritis treatment to work?

It depends on the medicine. Symptoms may begin to improve 3 to 6 weeks after starting methotrexate, and the full effect can take longer. Steroids work quickly, which is why they are sometimes used as a short bridge.

Can I stop my RA medicine if I feel better?

Please do not stop on your own. RA can come back when treatment is stopped. If you have been at your goal for a while, your rheumatologist may discuss slowly lowering the dose, but this should be planned together.

Are biologics safe?

Biologics help many people with RA, but they do raise infection risk. You will be screened before starting and checked during treatment. Talk with your doctor about your own risks and benefits.

Why did my doctor switch my medicine?

Under treat-to-target, the plan changes if you are not reaching your goal or if you have side effects. Switching is a normal part of finding what works for you.

The Bottom Line

Rheumatoid arthritis treatment usually starts with methotrexate, taken once a week, with your doctor adjusting the plan until you reach your goal. Other DMARDs, biologics and JAK inhibitors are options if needed, and JAK inhibitors carry an FDA boxed warning. Steroids are best for short-term help only. Ask about infections and vaccines before starting new medicines, and never stop or change your medicine without talking with your doctor.