[Does the general strategy for the treatment of rheumatoid polyarthritis need to be reviewed?]

At the start of the nineties, the therapeutic strategy for rheumatoid arthritis (RA) is still disappointing, and the natural history of this affection remains only slightly influenced by the treatments; a general re-assessment of the treatment seems therefore justified. Some new slow acting drugs are effective, but they cannot be considered as being therapeutic revolutions: gold salts per os, sulphasalazine, tiopronine whose efficacy is comparable to D-penicillamine without systematic cross interaction, methotrexate, cyclosporin which is difficult to manipulate. These observations encourage the search for new strategies, namely for the early treatment of the synovitis before the pannus and radiological signs appear. For this, the early and irrefutable diagnosis of RA must be made possible; and no completely reliable, early detection test is available yet. Though promising, the new therapeutic approaches, immunomanipulation or cell manipulation, do not revolutionize the evolution of this pathology. Other fields of research need to be developed, namely on the remission-inducing agents observed during pregnancy. It is still impossible to know which approach will provide the absolute weapon against RA.