Rheumatoid arthritis (RA) is a chronic in-flammatory disease with progressive joint damage, generally considered irreversible. A more aggressive therapeutic approach is promoted. Progression of joint damage, gradual functional disability and rate of mortality are lowered by disease modifying antirheumatic drugs (DMARD). Among these, we discuss the relative role of TNF inhibitors and their efficacy on preventing radiographic progression of joint damage. We also touch on the notion of a therapeutic window of opportunity early in the course of RA, as early initiation of aggressive treatment seems to provide a sustained benefit on radiographic progression.