Rheumatoid arthritis (RA) is a chronic autoimmune disorder. It causes your immune system to attack the healthy tissues in your joints, resulting in pain, swelling, and stiffness. Unlike osteoarthritis, which results from normal wear and tear as you age, RA can affect anyone at any age. No one knows exactly what causes it.

RA has no cure, but medications can help relieve symptoms. These medications include anti-inflammatory drugs, corticosteroids, and drugs that suppress the immune system. Some of the most effective drug treatments are disease modifying anti-rheumatic drugs (DMARDs), which include TNF-alpha inhibitors.

DMARDs are medications that rheumatologists often prescribe right after a diagnosis of RA. Much of the permanent joint damage from RA happens in the first two years, so these drugs can make a big impact early on in the course of the disease.

DMARDs work by weakening your immune system. This action reduces RA’s attack on your joints to lessen the overall damage.

Examples of DMARDs include:

  • methotrexate (Otrexup)
  • hydroxychloroquine (Plaquenil)
  • leflunomide (Arava)

The main downside to using DMARDs is that they’re slow to act. It can take several months to feel any pain relief from a DMARD. For this reason, rheumatologists often prescribe fast-acting painkillers such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) to take at the same time. These drugs can help reduce pain while you wait for the DMARD to take effect.

Examples of corticosteroids or NSAIDs that may be used with DMARDs include:


  • prednisone (Rayos)
  • methylprednisolone (Depo-Medrol)
  • triamcinolone (Aristospan)

Over-the-counter NSAIDs

  • aspirin
  • ibuprofen
  • naproxen sodium

Prescription NSAIDs

  • nabumetone
  • celecoxib (Celebrex)
  • piroxicam (Feldene)

DMARDs affect your entire immune system. This means they put you at a greater risk of infections.

The most common infections that RA patients have are:

To help prevent infections, you should practice good hygiene, including washing your hands often and bathing daily or every other day. You should also stay away from people who are sick.

Tumor necrosis factor alpha, or TNF alpha, is a substance that occurs naturally in your body. In RA, the immune system cells that attack the joints create higher levels of TNF alpha. These high levels cause pain and swelling. While several other factors add to RA’s damage in the joints, TNF alpha is a major player in the process.

Because TNF alpha is such a big problem in RA, TNF-alpha inhibitors are one of the most important types of DMARDs on the market right now.

There are five types of TNF-alpha inhibitors:

  • adalimumab (Humira)
  • etanercept (Enbrel)
  • certolizumab pegol (Cimzia)
  • golimumab (Simponi)
  • infliximab (Remicade)

These drugs are also called TNF-alpha blockers because they block the activity of TNF alpha. They reduce TNF alpha levels in your body to help decrease RA symptoms. They also begin to work more quickly than other DMARDs. They may start to take effect within two weeks to a month.

Most people with RA respond well to TNF-alpha inhibitors and other DMARDs, but for some people, these options may not work at all. If they don’t work for you, tell your rheumatologist. They will likely prescribe a different TNF-alpha inhibitor as a next step, or they may suggest a different kind of DMARD altogether.

Be sure to update your rheumatologist on how you’re feeling and how well you think your medication is working. Together, you and your doctor can find an RA treatment plan that will work for you.