It may take up to six months to see the maximal response, and it may never completely overcome the joint pains and stiffness. Hydroxychloroquine is also available only by prescription. It is taken twice daily, and has relatively few side effects. Concerns in the past about damage to the retina have not been substantiated by recent studies, and many specialists no longer require frequent eye exams. By itself it is effective in fewer people than methotrexate.
Etanercept is given by injection, twice weekly.
Infliximab is given by intravenous injection, and is only approved for use along with methotrexate. Both work more quickly than the older immunomodulating drugs, and a response is usually seen within a few weeks. They should not be given in the presence of infection, and since tumor necrosis factor is a natural protein in the body which has beneficial effects, including killing potential cancer cells, there is some concern that the drug will increase the risk of cancer in a person taking it. I have not personally taken or prescribed either of these drugs as yet. Physical therapy should be considered for everyone with RA, to maintain the strength and flexibility of the joints, and perhaps to slow the development of joint deformities.