Overexpression of tumour necrosis factor (TNF) in joints is a major contributor to the evolution and progression of rheumatoid arthritis (RA). Anti-TNF therapies have demonstrated efficacy in reducing joint pain and inflammation and slowing the progression of RA. A potential strategy to enhance therapeutic efficacy in RA is to combine an anti-TNF agent with a conventional disease-modifying antirheumatic drug (DMARD). This strategy has been evaluated in an international study involving over 600 patients with RA. Results from the study, which were presented at the 67th Annual Scientific Meeting of the American College of Rheumatology (ACR) [Orlando, US; October 2003], showed that combination therapy with the TNF receptor antagonist etanercept [Enbrel] plus the DMARD methotrexate resulted in significantly less radiographic progression of RA, and higher clinical response rates, compared with etanercept or methotrexate alone. Another study presented at the meeting indicated that early initiation of etanercept produced durable improvements in patients with RA. This study showed that initiating etanercept therapy in early-stage RA resulted in sustained inhibition of radiographic progression, and allowed a substantial number of patients to reduce the dosage of, or discontinue, corticosteroids and existing methotrexate therapy.