In the past years, the substantially increased number of potent drugs for the therapy of rheumatoid arthritis has made the goal of an early, highly effective therapy more feasible. In addition, combination therapy trials including biologics revealed that joint protection and downregulation of inflammation can be achieved also in stages of active articular destruction, and the detection of novel markers such as antibodies against cyclic citrullinated peptides supports an earlier diagnosis of the disease. The price for these advances, however, are more complex, demanding and expensive therapeutic regimens that need to be handled carefully by the rheumatologist, especially with regard to a new field of side effects inherent with the use of TNF inhibiting agents. Finally, the current therapeutic standard includes also the ongoing clinical and scientific exchange with the orthopedic surgeon to optimize the long-term treatment for the individual patient.