DMARDs (Disease-modifying antirheumatic drugs): Methotrexate can produce a better result. It may also help skin psoriasis. Other drug of choice is sulfasalazine. However, both of them cannot halt the progression of erosive joint disease.
Other: cyclosporine, retinoic acid derivatives (acitretin – teratogenic!) , and psoralens plus ultraviolet A light (PUVA) for skin lesions.
Anti-TNF (etanercept, infliximab, adalimumab, and golimumab) treatment should be the choice for those who with active synovitis and does not respond to standard DMARDs (Methotrexate)
Since Hydroxychloroquine causes skin problem, it is avoided.