Important facts about RA:

RA is a deforming disease. More than 50% of patients will have joint space narrowing in the first five years of the disease. It is thus extremely important to start on disease modifying drugs (DMD) almost immediately after confirmation of Diagnosis.

There are multiple options fo drug therapy.

Older agents are
Methotrexate
Sulfasalazie
Hydroxychloroquine

Other immnosuppressants.

Newer agents include two new classies of drugs.
TNF blockers: Etanercept (Enbrel), Infliximab (Remicade) which can also be used for Inflammatory bowel disease, and a new drug Adalimumab.

Then there is IL1 blocker: Anakinra.

TNF activates osteoclasts (causing periarticuar osteoporosis), synoiocytes (causing synovitis and swelling) and chondrocytes (causing joint space narowing and deformity).
TNF inhibitors and MTX can be used together.
Monitoring of patients on TNF blockers includes CBC q monthly because of possibility of Anemia and pancytopenia - although this has been seen in conjunction with use of agents like MTX/Cyclophosphamide etc which by themselves may be the culprits in this effect.
Occasionally neurologic disease has been reported with this like optic neuritis, MS and myelitis. Thus do not use in such patients for fear of worsening of hte underlying neuro problem.
Infections are another concern.
Tuberculosis has been a concern in patients on TNF blockers therefore alwasy investigate a lingering cough in such patients. Of those sho got TB, 55% also had extrapulmonary manifestations of TB. One should also consider checking patient CXR and PPD before starting to assist in monitoring