Efficacy of Tofacitinib, Methotrexate Combination Therapy Versus Upadacitinib, Methotrexate Combination Therapy in Moderate to Severe Rheumatoid Arthritis

Inclusion Criteria: \- 1.Patients of both gender (age ≥18 years). 2.Patients fulfill the ACR/EULAR 2010 classification criteria for rheumatoid arthritis. 3.Patients with DAS-28 CRP \>3.2 despite optimum dose and duration of methotrexate (20-25 mg/week for minimum one month). Exclusion Criteria: * 1.Recent or concurrent infection 2.Active or latent tuberculosis 3\. Hemoglobin (Hb) \< 8 g/dl 4. White blood cell count \< 4000/ micro L, Neutrophil count \< 1000/ micro L, Platelet count \< 100000/mm3 5. Live vaccines (rota virus, varicella, yellow fever) within 3 months prior to the first dose 6. Child-Pugh Class -C 7. Pregnant or planned for pregnancy and breastfeeding females of child-bearing potential 8. Evidence or history of malignancy, with the exception of adequately treated or excised non-metastatic basal or squamous cell cancer of the skin or cervical carcinoma in situ 9. New York Heart Association Class III and IV congestive heart failure 10. Previous history of thromboembolism, deep venous thrombosis, stroke, IHD