Recent advances in the management and treatment of rheumatoid arthritis (RA) have provided evidence for the importance of early diagnosis and treatment of the disease. Biological therapy with monoclonal antibodies, including anti-tumor necrosis factor (TNF) agents have shown major efficacy in terms of disease activity and outcome of inflammatory arthritis in trials. Interest has focused on the treatment of early rheumatoid arthritis with anti-TNF agents to induce long-term impact on outcome. A major study of etanercept versus methotrexate (MTX) showed some benefit at one year for the etanercept group, but long-term data have shown greater benefit. Two double-blind placebo-controlled studies of infliximab in patients with early RA yielded promising data, showing the possibility of a true 'window of opportunity' with long-term benefit from a short term treatment period. Aggressive treatment by anti-TNF agents as well as combination therapies of disease modifying anti-rheumatic drugs (DMARDs) in patients with very early disease would be a logical approach to be investigated in the future.