<P> Biological agents should generally only be used if methotrexate and other conventional agents are not effective after a trial of three months . They are associated with a higher rate of serious infections as compared to other DMARDs . Biological DMARD agents used to treat rheumatoid arthritis include: tumor necrosis factor alpha (TNFα) blockers such as infliximab; interleukin 1 blockers such as anakinra, monoclonal antibodies against B cells such as rituximab, and tocilizumab T cell co-stimulation blocker such as abatacept . They are often used in combination with either methotrexate or leflunomide . Abatacept should not be used at the same time as other biologics . In those who are well controlled on TNF blockers decreasing the dose does not appear to affect overall function . Persons should be screened for latent tuberculosis before starting any TNF blockers therapy to avoid reactivation . </P> <P> TNF blockers and methotrexate appear to have similar effectiveness when used alone and better results are obtained when used together . Golimumab showed significant effectivness when used with methotraxate . TNF blockers appear to have equivalent effectiveness with etanercept appearing to be the safest . Abatacept appears effective for RA with 20% more people improving with treatment than without but long term safety studies are yet unavailable . However, there is a lack of evidence to distinguish between the biologics available for RA . Issues with the biologics include their high cost and association with infections including tuberculosis . </P> <P> Glucocorticoids can be used in the short term and at the lowest dose possible for flare - ups and while waiting for slow - onset drugs to take effect . </P> <P> Non-NSAID drugs to relieve pain, like paracetamol may be used to help relieve the pain symptoms; they do not change the underlying disease . </P>

Which of the following is not a characteristic of rheumatoid arthritis