Drug*		Mechanism for rheumatoid arthritis	Adverse effects	Monthly cost †
Nonbiologic
More commonly used
	Methotrexate	Inhibits dihydrofolate reductase	Liver effects, teratogenesis, hair loss, oral ulcers	$
	Leflunomide (Arava)	Inhibits pyrimidine synthesis	Liver effects, gastrointestinal effects, teratogenesis	$
	Hydroxychloroquine (Plaquenil)	Antimalarial, blocks toll-like receptors	Rare ocular toxicity	$$
	Sulfasalazine (Azulfidine)	Folate depletion, other mechanisms unknown	Anemia in G6PD deficiency, gastrointestinal effects	$
	Minocycline (Minocin)	Antimicrobial, other mechanisms unknown	Drug-induced lupus erythematosus, Clostridium difficile colitis	$
Less commonly used
	Gold sodium thiomalate	Inhibits antigen processing, decreases cytokines (TNF, interleukin-6)	Skin, heme, renal effects	$$
	Penicillamine (Cuprimine)	Chelates metal, other mechanisms unknown	Heme, renal effects	$$
	Cyclophosphamide	Nitrogen mustard alkylating agent, cross-links DNA	Infertility, cancer, hemorrhagic cystitis	$$
	Cyclosporine (Sandimmune)	Calcineurin inhibitor, decreases interleukin-2	Hypertension, renal effects, hirsutism	$$
Biologic
Anti-TNF agents
	Adalimumab (Humira)	Anti-TNF-α	TB, opportunistic infection	$$$
	Certolizumab pegol (Cimzia)	Anti-TNF-α, pegylated	TB, opportunistic infection	$$$
	Etanercept (Enbrel)	Anti-TNF-α, receptor	TB, opportunistic infection	$$$
	Golimumab (Simponi)	Anti-TNF-α	TB, opportunistic infection	$$$
	Infliximab (Remicade)	Anti-TNF-α	TB, opportunistic infection, infusion reaction	$$$
Other biologic agents
	Abatacept (Orencia)	Costimulator blocker, cytotoxic T lymphocyte antigen 4	Opportunistic infection	$$$
	Anakinra (Kineret)	Anti-interleukin-1 receptor blocker	Opportunistic infection, injection site pain	$$$
	Rituximab (Rituxan)	Anti-CD20, eliminates B cells	Infusion reaction, opportunistic infection, progressive multifocal leukoencephalopathy	$$$$
	Tocilizumab (Actemra)	Anti-interleukin-6 receptor blocker	Opportunistic infection	$$$