Rheumatoid arthritis causes inflammation of the joints and often produces pain, deformity, and disability. The cause of the disease is unknown, but doctors know that the disease produces inflammation of the joint surfaces where the cartilage-covered ends of the bones rub against each another as the joint bends. Prolonged inflammation damages the joint and produces permanent changes in its structure. Doctors have used many medications to decrease joint inflammation and have been successful in managing the disease. Although some of that success has been achieved by using progressively more powerful disease-modifying antirheumatic drugs and medications that control inflammation, success also seems to be due in part to the way that doctors use combinations of these medications. To determine the best ways of treating rheumatoid arthritis early in the course of the disease, researchers began a study (known as the BeSt study) of patients who were treated with 1 of 4 plans. Group 1 received a single drug that was changed to another powerful drug every 3 months until the disease was controlled. Group 2 also started therapy with a single drug that was progressively stepped-up to combination therapy until control was achieved. Group 3 received combination therapy and high-dose prednisone until control was achieved. Group 4 received combination therapy and a new drug (infliximab) that blocks the body's ability to develop inflammation. In all groups, therapy was adjusted every 3 months until there was adequate disease control. Medication doses were reduced in all groups once the disease was controlled. Results during the first year showed that although all groups improved, groups 3 and 4 had more rapid control of the disease and had less damage to the joints than did groups 1 and 2.