Because rheumatoid arthritis rarely remits, refractory disease is comm
on. Attention should be paid to aggravating comorbid conditions. Pharm
acologic options currently available include cyclosporin, high-dose me
thotrexate, combination second-line agents, and creative use of cortic
osteroids. The available literature is reviewed in this article and th
e potential risks and benefits of the various options are discussed.