What's the difference between DMARDs and biologics?
Conventional DMARDs (methotrexate, sulfasalazine, hydroxychloroquine, leflunomide) are the first-line drugs for RA and other inflammatory arthritis — cheap, taken by mouth, and effective for the majority of people. Biologics (adalimumab, etanercept, tocilizumab and others) are injected or infused, target specific parts of the immune system, and are added when DMARDs alone aren't enough. NHS NICE guidance sets clear criteria for stepping up.
Last updated 2026-07-04. This is general information, not a substitute for personalised medical advice.
Frequently asked questions
When would you pick Conventional DMARDs (e.g. methotrexate)?
First-line for RA, PsA, some other inflammatory arthritis; NICE requires trying these first.
When would you pick Biologics (e.g. adalimumab, etanercept)?
When DMARDs alone don't achieve remission (usually after 3-6 months of adequate dose).
What should I be careful about?
Both need regular blood monitoring. Never stop suddenly without medical advice — flare risk.