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Introduction: the future of rheumatoid arthritis management.

This review provides a state-of-the-art assessment of current approaches to rheumatoid arthritis (RA). This is an area that has advanced considerably in the last few years. There is now a general agreement that the ambition of the treatment of early RA should be remission and that targeted approaches are the best way to achieve this. There is less consensus on whether an aggressive remission-induction (with subsequent withdrawal of therapy) is optimal and whether biologic therapy should be part of this approach. Certainly, the data suggest that an early remission can be achieved with biologics and that less radiographic progression occurs. A key issue is whether this is cost-effective. One area of growing consensus is that early achievement of remission in milder patients does allow withdrawal of biologics if these are used at first instance.