The individual and societal impacts of rheumatoid arthritis are of substantial consequence. Management of the disease has pharmacologically focused on the use of anti-inflammatories and disease-modifying antirheumatic drugs, which are only partially successful in retarding joint destruction and functional disability. The recent emergence of cytokine antagonists (anti-tumor necrosis factor therapy) challenges clinicians and managed care organizations with the need to develop new treatment guidelines. Recent developments in the understanding of rheumatoid arthritis, including its epidemiological characteristics, economic costs, clinical progression, and current and emerging therapies, are reviewed. Pharmacologic utilization models are proposed. Pending the development of broad-based consensus treatment recommendations, interim treatment guidelines are suggested.