Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that leads to cartilage and bone damage, causing disability. Early diagnosis and well-characterized risk factors, such as high disease activity, autoantibodies, and early damage, are crucial for optimal therapeutic success. Treatment algorithms involve measuring disease activity with composite indices, applying a treatment-to-target strategy, and using conventional and novel biologic and non-biologic disease-modifying antirheumatic drugs (DMARDs). Once stringent remission or low disease activity is achieved, dose reduction or interval increases should be considered. While current therapies have improved outcomes for most patients, many do not respond, necessitating new treatments. This seminar covers current insights into genetics, etiology, pathophysiology, epidemiology, assessment, therapeutic agents, and strategies, as well as unmet needs in RA. Despite progress, the pathogenetic mechanisms remain complex, and many patients do not achieve deep remission. The seminar highlights the importance of early diagnosis, regular disease activity assessment, and tailored treatment approaches to maximize outcomes.Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that leads to cartilage and bone damage, causing disability. Early diagnosis and well-characterized risk factors, such as high disease activity, autoantibodies, and early damage, are crucial for optimal therapeutic success. Treatment algorithms involve measuring disease activity with composite indices, applying a treatment-to-target strategy, and using conventional and novel biologic and non-biologic disease-modifying antirheumatic drugs (DMARDs). Once stringent remission or low disease activity is achieved, dose reduction or interval increases should be considered. While current therapies have improved outcomes for most patients, many do not respond, necessitating new treatments. This seminar covers current insights into genetics, etiology, pathophysiology, epidemiology, assessment, therapeutic agents, and strategies, as well as unmet needs in RA. Despite progress, the pathogenetic mechanisms remain complex, and many patients do not achieve deep remission. The seminar highlights the importance of early diagnosis, regular disease activity assessment, and tailored treatment approaches to maximize outcomes.