Upadacitinib (Rinvoq)
Upadacitinib (Rinvoq) is an oral medication that belongs to a class of drugs called Janus kinase (JAK) inhibitors. It is used to treat several autoimmune diseases, including giant cell arteritis (GCA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA). It is also approved to treat Crohn's disease, ulcerative colitis (UC), and moderate to severe atopic dermatitis in adults and in children aged 12 years and older.
Upadacitinib works by blocking Janus kinase (JAK) enzymes, which play an important role in the inflammatory process. By reducing JAK activity, it helps decrease inflammation, relieving symptoms such as pain, swelling, and stiffness, and may help prevent further joint damage in inflammatory arthritis. Upadacitinib may be used alone or in combination with methotrexate.
How to Take It
Upadacitinib is a tablet that is taken once per day. Taking upadacitinib with food may decrease nausea or other gastrointestinal distress you may feel. Upadacitinib may be used alone or in combination with methotrexate or other conventional disease modifying antirheumatic drugs (cDMARDs). Upadacitinib should not be given in combination with another biologic drug or other medications that lower your immune system. Some patients will start to see improvement within a few weeks, but it may take several months to take full effect.
Side Effects
Upadacitinib can weaken your immune system and increase your risk of infections. All patients should be tested for tuberculosis and hepatitis B before starting this medication. Upadacitinib increases your chance of getting shingles so talk to your doctor about a vaccine for shingles. In patients over 50 years of age with at least one heart disease risk factor (such as smoking, history of heart attack, obesity, high blood pressure, high cholesterol), upadacitinib carries a warning for increased risk of heart attacks, strokes, and blood clots because it works like other medications that have caused those events. A rare complication seen with upadacitinib in clinical trials was bowel perforation, or a hole in the bowel wall, and cancer. Blood tests will be used to monitor increases in cholesterol or liver enzymes and for reductions in blood cell counts while taking upadacitinib.
Tell Your Rheumatology Provider
If you develop symptoms of an infection such as a fever or cough, or allergic reactions, or think you are having any side effects (especially stomach pain, blood in the stool), contact your rheumatologist. Let your doctor know if you have a history of diverticulitis or serious infections. Tell your doctor if you become pregnant, are planning pregnancy, or if you are breastfeeding, as the medicine has not been determined to be safe for pregnancy. Ask your doctor about getting appropriate vaccines before starting upadacitinib and avoid live vaccines like the nasal spray flu vaccine, measles, mumps, rubella, or yellow fever vaccines. Be sure to talk with your doctor before undergoing any surgery while taking this medication.
Updated August 2026 by Shreena Gandhi, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.