[If I had chronic polyarthritis--current ideas on basic therapy]

Rheumatoid arthritis (RA) is a chronic inflammatory disorder of largely unknown etiology and complex multifactorial pathogenesis. To date, the medical management has been less than optimal and has consisted primarily of drugs that modulate the acute inflammatory process. Over the years a treatment program referred to as the classical therapeutic pyramid has evolved. A new concept and a controversial one in therapy of RA is that already at the time of definitive diagnosis, a more concerted effort towards vigorous treatment using second-line drugs such as methotrexate, should be made. It is very likely that over the next 5 years interventions such as monoclonal antibodies directed against predetermined T-cell subpopulations and anti-cytokines such as TNF-alpha binding proteins will evolve as new concepts in therapy of RA.