The oral disease-modifying antirheumatic drug (DMARD) leflunomide was approved by the US FDA in 1998, making it the first newly approved treatment for adult rheumatoid arthritis (RA) in more than 10 years. Already shown to retard structural damage and reduce the signs and symptoms of RA at all stages of disease, data are now starting to emerge on its use over the long term and in combination with methotrexate, the current gold standard. While rheumatologists have not given up on traditional DMARDs, which tend to be cheaper and certainly effective in a large number of patients, there is mounting evidence that starting with an older, less effective DMARD may not be the optimal course of treatment. There is considerable interest in how leflunomide ['Arava'] stacks up in long-term treatment. Thus, at the 64th Annual Scientific Meeting of the American College of Rheumatology (ACR) [Philadelphia, US; October-November 2000], researchers from the Leflunomide Study Group reported 2-year data from 3 large phase III trials.1