DMARD	Dosage	Cost (generic)*	Time to benefit	Adverse effects	Monitoring†	Comments
Adalimumab (Humira)	40 mg SC every two weeks	$1,316	A few days to four months‡	Infusion reactions; increased infection risk, including TB reactivation	Monitor for TB, histoplasmosis, and other infections; CBC and ALT at baseline and monthly until dose is stable; may continue every two to three months thereafter.	Monoclonal antibody to TNF-3; shown to reduce disease activity with acceptable safety.
Adalimumab (Humira)	40 mg SC every two weeks	$1,316	A few days to four months‡	Rare: demyelinating disorders
Anakinra (Kineret)	100 to 150 mg SCper day	1,251	Within 12 weeks; lasting effects by 24 weeks	Infections and decreased neutrophil counts; headaches, dizziness; nausea	CBC at baseline, monthly for three months, then every three months	Interleukin-1 receptor antagonist; used when treatment with another DMARD has failed.
Anakinra (Kineret)	100 to 150 mg SCper day	1,251	Within 12 weeks; lasting effects by 24 weeks	Rare: hypersensitivity
Auranofin (Ridaura)	3 mg orally twice per day or 6 mg orally per day	215	Four to six months	Diarrhea	CBC and urine protein (by dipstick) every one to three months	Has modest effects compared with other DMARDs.
Auranofin (Ridaura)	3 mg orally twice per day or 6 mg orally per day	215	Four to six months	Rare: leukopenia		Has modest effects compared with other DMARDs.
Azathioprine (Imuran)	50 to 150 mg orally per day	76 (39 to 40)	Two to three months	Nausea	CBC every one to two weeks until dose is stable, then every one to three months	Has greater toxicity and is used less commonly than other DMARDs.
Azathioprine (Imuran)	50 to 150 mg orally per day	76 (39 to 40)	Two to three months	Rare: leukopenia; sepsis; lymphoma
Cyclosporine (Gengraf, Neoral, generic)	2.5 to 5 mg per kgorally per day	288 to 231 (288 to 326)	Two to four months	Nausea; paresthesias, tremor; headaches; gingival hypertrophy; hypertrichosis	Creatinine every two weeks until dose is stable, then monthly; consider CBC, LFTs, and potassium level tests	Significant clinical benefit up to one year; adverse effects limit use.
Cyclosporine (Gengraf, Neoral, generic)	2.5 to 5 mg per kgorally per day	288 to 231 (288 to 326)	Two to four months	Rare: hypertension; renal disease; sepsis
D-Penicillamine (Cuprimine)	250 to 750 mg orally per day	35 to 95	Three to six months	Nausea; loss of taste; rash; reversible platelet decrease	CBC and urinary protein by dipstick every two weeks until dose is stable, then every one to three months	Used less commonly than other DMARDs.
D-Penicillamine (Cuprimine)	250 to 750 mg orally per day	35 to 95	Three to six months	Rare: proteinuria; late autoimmune disease		Used less commonly than other DMARDs.
Etanercept (Enbrel)	25 mg SC twice per week or 50 mg SC per week	1,316	A few days to 12 weeks	Contraindicated in infection; mild injection site reactions	CBC and ALT at baseline and monthly until dose is stable; may continue every two to three months thereafter.	Combination of TNF receptor and portion of IgG1; inhibits TNF-3; slows joint damage.
Etanercept (Enbrel)	25 mg SC twice per week or 50 mg SC per week	1,316	A few days to 12 weeks	Rare: demyelination
Hydroxychloroquine (Plaquenil)	200 to 400 mg orally per day	57 (33 to 37)	Two to six months	Nausea; headaches	Eye examinations every 12 months in patients older than 40 years and those with previous eye disease	Can be used when diagnosis uncertain; moderate effect but relatively low toxicity.
Hydroxychloroquine (Plaquenil)	200 to 400 mg orally per day	57 (33 to 37)	Two to six months	Rare: abdominal pain; myopathy; retinal toxicity
IM gold Gold sodium thiomalate (Myochrysine) Aurothioglucose (Solganal)	25 to 50 mg IM every two to four weeks	34	Six to eight weeks	Mouth ulcers; rash; vasomotor symptoms after injection	CBC and urinary protein by dipstick every two weeks until dose is stable, then with each injection	Has significant withdrawal rate in trials because of toxicity.
	25 to 50 mg IM every two to four weeks	34	Six to eight weeks	Rare: leukopenia; thrombocytopenia; proteinuria; colitis
Infliximab (Remicade)	3 mg per kg IV at weeks zero, 2, and 6, then every eight weeks§	1,383 (for eight weeks)	A few days to four months‡	Infusion reactions; increased infection risk, including TB reactivation	Monitor for TB, histoplasmosis, and other infections; CBC and ALT at baseline and monthly until dose is stable; may continue every two to three months thereafter.	Monoclonal antibody to TNF-3; reduces disease activity with acceptable safety.
Infliximab (Remicade)		1,383 (for eight weeks)	A few days to four months‡	Rare: demyelinating disorders
Leflunomide (Arava)	100 mg orally per day for three days, then 10 to 20 mg orally per day	372	Four to 12 weeks (tending toward four)	Nausea, diarrhea; rash; alopecia; highly teratogenic, even after discontinuation	Hepatitis B and C serology in high-risk patients; CBC, creatinine, and LFTs monthly for six months, then every one to two months; repeat AST or ALT in two to four weeks if initially elevated, and adjust dose as needed.	Inhibits pyrimidine synthesis and may suppress T-cell activation; improves multiple clinical outcomes and delays radiographic changes; can be eliminated from system with cholestyramine in patients wishing to conceive.
Leflunomide (Arava)		372	Four to 12 weeks (tending toward four)	Rare: leukopenia; hepatitis; thrombocytopenia
Methotrexate	12 to 25 mg orally, IM, or SC per week	Oral: 79 (57 to 65) IM or SC: (18 to 20)	One to two months	Nausea, diarrhea; fatigue; mouth ulcers; rash, alopecia; abnormal LFTs	CBC, creatinine, and LFTs monthly for six months, then every one to two months; repeat AST or ALT in two to four weeks if initially elevated, and adjust dose as needed; liver biopsy if no resolution on discontinuation.	Rapid onset (six to 10 weeks); tends to produce more sustained results over time than other DMARDs and lowers all-cause mortality; can be used when cause of polyarthritis uncertain; often combined with newer DMARDs.
Methotrexate	12 to 25 mg orally, IM, or SC per week	Oral: 79 (57 to 65) IM or SC: (18 to 20)	One to two months	Rare: low WBC and platelets; pneumonitis; sepsis; liver disease; Epstein-Barr virus–related lymphoma; nodulosis
Minocycline (Minocin)	100 mg orally twice per day	231 (115 to 147)	One to three months	Dizziness; skin pigmentation	None needed	Effective in combination with prednisone for management of new-onset rheumatoid arthritis.
Staphylococcal protein A immunoadsorption (Prosorba column)	Extracorporeal; weekly for 12 weeks	20,433	Three months	Hypotension and anemia during procedure; catheter site infection, joint pain, fatigue	Follow CBC	Used only in refractory patients when many other treatments have failed.
Sulfasalazine (Azulfidine)	2 to 3 g orally per day in divided doses	48 (14 to 31)	One to three months	Nausea, diarrhea; headache; mouth ulcers; rash, alopecia; contact lens staining; reversible oligospermia; abnormal LFTs	CBC every two to four weeks for three months, then every three months	Rapid onset (eight to 13 weeks); enteric, coated forms available; can be used when diagnosis uncertain; modest effects compared with other medications.
Sulfasalazine (Azulfidine)	2 to 3 g orally per day in divided doses	48 (14 to 31)	One to three months	Rare: leukopenia