Based on the author's experience and data of numerous studies, principles and current strategic approaches to the treatment of severe chronic diseases such as rheumatoid arthritis (RA) are presented. Treatment of RA is aimed to suppression the activity of inflammation and progression of the disease. Symptomatic therapy of the inflammatory process includes use of nonsteroidal or steroid anti-inflammatory drugs, as well as the slow-release basic anti-inflammatory drugs (BAIDs). In accordance to recommendations of the Association of Rheumatologists of Russia, the main medications in treatment of RA are methotrexate, leflunomide and sulfasalazine. BAIDs should be administred as early as possible - preferably in the first 3 months of onset of symptoms. Course of treatment requires careful monitoring of treatment success and tolerability of therapy, and assessment of actual risk of emerging side effects. In the case of insufficient effects of therapy, physicians should change BAIDs, treatment dose, combine different BAIDs or optimize treatment of patients with RA by adding to the therapy of genetically engineered biological preparations.

Keywords: leflunomide, basic anti-inflammatory drugs, genetically engineered biological preparations, methotrexate, rheumatoid arthritis