Comprehensive meta-analyses have revealed that survival on DMARD therapy in rheumatoid arthritis can be classified according to several factors: the number of adverse drug reactions, the percentage of drop-outs, and the duration of usage, which is clearly linked to both drug efficacy and drug toxicity. When taking into account of all of these issues, the impact of each DMARD can be scored differently, but certainly the length of time on a given DMARD gives us a conclusive, clinically important overview of its overall efficacy and safety. On these grounds, studies lasting two years or more have demonstrated that, while sulphasalazine can be employed for a median length of 12 months, methotrexate treatment can be maintained for more than 5 consecutive years. Severe and life-threatening complications have been observed with all conventional DMARDs.