Rheumatoid arthritis (RA) is a serious disease that can lead to permanent disability from joint destruction. Methotrexate is the most common drug now used to initially treat moderate to severe RA. Additional drugs, such as cyclosporine or “biologic” treatments, are often added to control the disease as soon and as completely as possible. They may be given with methotrexate from the beginning of treatment and then decreased when the disease is under control or may be added to methotrexate later if improvement is incomplete or slow. These additional drugs are effective but have their own side effects, are costly, and add to the complexity of treatment for patients.