Disease-modifying antirheumatic drug (DMARD) therapy is now clearly accepted as 
the primary treatment for rheumatoid arthritis, with an increasing emphasis on 
use of combination therapy. Data on combination therapy have highlighted the 
difficulties in performing these studies and the large number of patients 
required to produce meaningful results. Combination studies have focused on use 
of rapidly decreasing high-dose steroids as a part of the combination and 
emphasize the importance of using patients with early rheumatoid arthritis. Even 
with relatively aggressive use of DMARDs, the majority of patients develop 
erosions. Adverse reactions to DMARDs continue to concern clinicians, although 
evaluation of the frequency of these events has led to a reappraisal of 
previously accepted monitoring strategies in some cases. For example, it may not 
be cost-effective to subject patients on antimalarials to regular review by an 
ophthalmologist because of the low frequency of serious eye defects. Studies 
have also identified risk factors for the development of pulmonary toxicity in 
association with methotrexate. That DMARDs are effective in treating rheumatoid 
arthritis is beyond question-just how effective they are and what combinations 
of DMARDs will show improved efficacy will provide data for the next annual 
review.