Over the past 15 years or so, there have been revolutionary changes in the treatment strategies of rheumatoid arthritis (RA). The traditional pyramidal approach has largely been replaced by the aggressive use of disease-modifying antirheumatic drugs (DMARDs) in early disease. There has been continuing excitement with the introduction and use of the newer biological agents. While these novel agents have added to the armamentarium of RA treatment, rheumatologists are faced with the dilemma of drug cost and treatment effectiveness. In this article, the current concept of RA therapies and data regarding the newer biological response modifiers are discussed.