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recommended to protect the stomach from the ulcer effects of NSAIDs.

Corticosteroid medications can be given orally or injected directly into tissues and joints. They are more potent than NSAIDs in reducing inflammation, and in restoring joint mobility and function. Corticosteroids are useful for short periods during severe flares of disease activity, or when the disease is not responding to NSAIDs. However, corticosteroids can have serious side effects, especially when given in high doses for long periods of time. These side effects can be partially avoided by gradually tapering the doses of corticosteroids as the patient achieves improvement of the disease. Abruptly discontinuing corticosteroids can lead to flares of the disease or other symptoms of corticosteroid withdrawal, and is discouraged.

2.slow-acting "second-line drugs" (also referred to as Disease-Modifying Antirheumatic Drugs or DMARDs) which includes gold, methotrexate, hydroxychloroquine (Plaquenil),Sulfasalazine (Azulfidine) and D-penicillamine (Depen, Cuprimine) promote disease remission and prevent progressive joint destruction, but they are not anti-inflammatory agents.
Both classes are mixed for certain patients to obtain relief. Some patients are treated by injecting certain drugs directly and locally into the joints.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira). Leflunomide (Arava) is available to relieve the symptoms and halt the progression of the disease. It seems to work by blocking the action of an important enzyme that has a role in immune activation.
Etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) are biologic medications. These medications intercept a protein in the joints (tumor necrosis factor, or TNF) that causes inflammation before it can act on its natural receptor to "switch on " inflammation.
Anakinra (Kineret) is another biologic treatment that is used to treat moderate to severe rheumatoid arthritis. Anakinra (Kineret) works by binding to a cell messenger protein (IL-1, a proinflammation cytokine).
Rituxan can be effective in treating autoimmune diseases like rheumatoid arthritis because it depletes B-cells, which are important cells of inflammation and in producing abnormal antibodies that are common in these conditions. Rituxan is now available to treat moderate to severely active rheumatoid

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