Rheumatoid arthritis (RA) is a serious, chronic, debilitating disease for which no cure is available. Therapeutic aims for patients with RA are to alleviate symptoms, slow disease progression and optimize quality of life. In recent years, measures to achieve these goals have changed, and the development of new drugs will probably result in new treatment regimens. Two drugs with an extensive record of clinical experience are methotrexate and cyclosporin. Methotrexate is widely used because of its efficacy and high therapy retention rate. Both drugs have been shown to slow the progression of RA, but not without side-effects that sometimes preclude their use. As neither drug generally induces remission, improved treatments are needed. Combination therapy using drugs with different mechanisms of action is beginning to be evaluated, as are biological response modifiers targeted to specific mediators of the immune response. The future treatment of RA should provide more effective relief with fewer side-effects.