The first line of treatment are the NSAIDs (non-steroidal anti inflammatory drugs) like indomethacin, diclofenac, naproxen etc. No NSAID is superior to another. These drugs give relief from pain for most patients. For joint and tendon related pains local injections of steroids (localized joint pain, tendon sheaths) or oral steroids (multiple joint pains) are effective. If there is no response to the above treatment, disease modifying antirheumatic drugs (DMARDs) such as sulfasalazine, methotrexate, leflunomide may be useful. If there is no response to DMARDs, then biological injections like TNF alpha blockers or IL-17 blockers can be used. Biologics like TNF alpha blockers are the most effective drugs available in treating the spinal and peripheral joint symptoms. Examples of TNF alpha blockers available in our country are infliximab (administered as Intravenous infusion), etanercept, adalimumab, golimumab (administered under the skin).