Rheumatoid arthritis remains a difficult disease to treat but new medications are making significant inroads into what used to be a crippling illness for almost everyone with this diagnosis. It has been 20 years since the advent of the biologic drugs starting with Enbrel and Remicaide. There are now over 9 drugs which can help stop the disease and prevent further bone destruction as seen on xray. A new oral medication has also been released this year and we are still sorting out the order of which medications work best for which aspect of rheumatoid arthritis as well as psoriasis, psoriatic arthritis, ankylosing spondylitis. In addition, off label studies with these drugs show promise for other diseases such as sarcoid, reactive arthritis, polymyositis among others. Side effects include infection and anyone who has seen these adds on television know that the list is long but in reality, infection in 3-4% of patients is the major issue we carefully watch for. Nevertheless, there is not much more gratification than seeing someone who can hardly move before starting these medications regain their ability to work and enjoy life.