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Recent advancements in treatment have helped more patients with RA to live healthy and productive lives.

It gives clinicians an advantage by providing alternative antirheumatic therapy when other remittive agents, such as gold compounds, sulfasalazine, steroids and methotrexate, must be discontinued because of poor efficacy or intolerable side effects.

There is potentially a wide choice of combination regimens available, many of which remain untested in randomized trials.

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However, recent research has indicated injections may provide longer suppression of disease activity.

It has regained popularity, however, and is now used for both adult and juvenile RA.

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Different strategies () favor a step-up (sequential addition of new DMARDs to existing treatment), a step-down (initial use of multiple DMARDs with subsequent withdrawal once remission is achieved) or a parallel approach (simultaneous use of two or more DMARDs); however, there is no consensus regarding either the most effective strategy, or the combination of DMARDs for the treatment of RA.

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However, the use of both traditional disease-modifying antirheumatic drugs (DMARDs) and TNF blockers needs to be continued indefinitely to sustain clinical benefit.

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