The following drugs are considered as DMARDs: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, TNF-alpha inhibitors (certolizumab, infliximab and etanercept), abatacept, and anakinra. Rituximab and tocilizumab are monoclonal antibodies and are also DMARDs.[8] Use of tocilizumab is associated with a risk of increased cholesterol levels.[87]

Hydroxychloroquine, apart from its low toxicity profile, is considered effective in the moderate RA treatment.[88]

The most commonly used agent is methotrexate with other frequently used agents including sulfasalazine and leflunomide.[8] Leflunomide is effective when used from 6–12 months, with similar effectiveness to methotrexate when used for 2 years.[89] Sulfasalazine also appears to be most effective in the short-term treatment of rheumatoid arthritis.[90] Sodium aurothiomalate (gold) and cyclosporin are less commonly used due to more common adverse effects.[8] However, cyclosporin was found to be effective in the progressive RA when used up to one year.[91] Agents may be used in combinations however, people may experience greater side effects.[8][92] Methotrexate is the most important and useful DMARD and is usually the first treatment.[8][5][93] A combined approach with methotrexate and biologics improves ACR50, HAQ scores and RA remission rates.[94] Triple therapy consisting of methotrexate, sulfasalazine and hydroxychloroquine may also effectively control disease activity.[95] Adverse effects should be monitored regularly with toxicity including gastrointestinal, hematologic, pulmonary, and hepatic.[93] Side effects such as nausea, vomiting or abdominal pain can be reduced by taking folic acid.[96]