Early aggressive and rational treatment with DMARDs is the key to reduce disability. It is important to note that drug selection should be consistent with the principles of safety, effectiveness, economy and simplicity. DMARDs therapy should be started as soon as rheumatoid arthritis is diagnosed. MTX is recommended as the first choice, but salazosulfapyridine or hydroxychloroquine may also be used. Depending on the disease, two or more DMARDs can be used alone or in combination. In general, patients with progressive, poor prognosis and refractory rheumatoid arthritis who do not do well with one DMARDs alone can be treated with a combination of DMARDs with different mechanisms. For example, MTX can be selected from 7.5 to 25 mg/week and salazosulfapyridine 1.0 to 3.0 g/d. Currently, the following combination regimens are commonly used: ①MTX + salazosulfapyridine; ②MTX + hydroxychloroquine (or chloroquine); ③MTX + penicillamine; 4. MTX + kinolfine; ⑤MTX + azathioprine; ⑥ salazosulfapyridine + hydroxychloroquine. Combination therapy with MTX and botanicals (e.g., leucovorin, penicillin and total glucoside of peony) is also available in China. If patients cannot tolerate MTX, they can switch to leflunomide or other DMARDs. Refractory rheumatoid arthritis can be treated with a combination of MTX + leflunomide or multiple DMARDs. When combining drugs, the dose of each drug can be reduced appropriately. It is important to emphasize again that regardless of the treatment option, x-rays of both hands (including the wrist) or symmetrical x-rays of the affected joints must be taken before treatment, and the x-rays should be reviewed yearly after treatment to compare the efficacy. In order to avoid adverse drug reactions, blood and urine routine, liver and kidney function should be closely monitored and the dose should be adjusted at any time during the course of treatment. The evaluation of treatment response should include the evaluation of functional status and the overall assessment of disease activity by the physician and the patient, in addition to the comparison of joint tenderness, swelling and number of joints before and after treatment, and radiological changes in the affected joints. The activity of the disease should be monitored in all patients. Patients with early, acute, or persistent disease activity should be followed closely until the disease is controlled. Patients in remission can be followed up every six months, and at the same time, the appropriate indicators should be tested regularly according to the requirements of the therapeutic drugs.