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Anti-rheumatic Drugs: DMARDs : Nonbiologic DMARDs methotrexate , hydroxychloroquine, leflunomide, sulfasalazine : Biologic DMARDs : TNF- inhibitors adalimumab , certolizumab, etanercept , golimumab, infliximab IL-6 receptor antagonists : tocilizumab : Targeted Biologic DMARDs Janus Kinase Inhibitors : tofacitinib, baricitinib, upadacitinib Adjuctive therapies for flare management: NSAIDs, Corticosteroids Anti-inflammatory Drugs : Analgesics : Acetaminophen & Opioids Treatment for methotrexate side effects/toxicity: Folinic acid (Leucovorin) Pathogenesis Figure 3