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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Biologic response modifiers: These agents act like substances produced normally in the body and block other natural substances that are part of the immune response. They block the process that leads to inflammation and damage of the joints. These are targeted treatments that are directed at specific sites in the immune system that are involved in the rheumatoid process.

• Etanercept (Enbrel): This agent blocks the action of tumor necrosis factor, which in turn decreases inflammatory and immune responses. It is given by subcutaneous injection twice weekly. People taking etanercept must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Infliximab (Remicade): This antibody blocks the action of tumor necrosis factor. It is often used in combination with methotrexate in people whose rheumatoid arthritis does not respond to methotrexate alone. It is given by intravenous infusion every six to eight weeks. People taking infliximab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Adalimumab (Humira): This is another blocker of tumor necrosis factor. It reduces inflammation and slows or stops worsening of joint damage in fairly severe rheumatoid arthritis. It is given by subcutaneous injection every two weeks. People taking adalimumab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Certolizumab (Cimzia): This is another blocker of tumor necrosis factor. It reduces inflammation and slows or stops worsening of joint damage in fairly severe rheumatoid arthritis. It is given by subcutaneous injection every four weeks. People taking certolizumab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Golimumab (Simponi): This is another blocker of tumor necrosis factor. It reduces inflammation and slows or stops worsening of joint damage in fairly severe rheumatoid arthritis. It is given by subcutaneous injection every four weeks. People taking golimumab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Anakinra (Kineret): This agent blocks the action of interleukin-1, which is partly responsible for the inflammation of rheumatoid arthritis. This in turn blocks inflammation and pain in rheumatoid arthritis. This agent is usually reserved for people whose rheumatoid arthritis has not improved with DMARDs. It is given by subcutaneous injection daily. People taking anakinra must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Abatacept (Orencia): This agent inhibits T-lymphocytes that contribute to the inflammation and pain associated with rheumatoid arthritis. This drug is reserved for individuals who do not respond to DMARDs, methotrexate, or TNF blockers. It is administered by intravenous infusion. Abatacept may increase the risk of serious infections.
• Rituximab (Rituxan): Given by intravenous infusion over four to five hours, twice, two weeks apart, every four to 10 months, this biologic response modifier decreases the number of B-cells, a type of immune cell that plays an integral role in causing rheumatoid inflammation and damage. Rituximab may increase the risk of serious infections.
• Tocilizumab (Actemra): The agent blocks the chemical messenger interleukin-6 (IL-6) that plays a role in activating the immune system that is responsible for rheumatoid arthritis. Tocilizumab is given intravenously once a month. Regular blood testing is required to monitor for potential side effects on blood cells, liver, and cholesterol levels.

Glucocorticoids: These very potent agents rapidly block inflammation and other immune responses. They are often called steroids. These agents all work in the same way; they differ only in their potency and in the form in which they are given. Steroids may be given as pills, intravenously, or as injections into a muscle or directly into a joint. In high doses, they can cause many serious side effects and are therefore given only for the shortest possible periods and under strictly controlled circumstances. These drugs should never be stopped abruptly.

• Prednisone (Deltasone, Meticorten, Orasone)
• Prednisolone (Medrol)
• Betamethasone (Celestone)

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