It is well known that rheumatoid is an autoimmune disease, and the occurrence and pathogenic process of rheumatoid is closely related to the patient’s own immune dysfunction. Although we now generally believe that the immune system in rheumatoid patients is dysfunctional, probably due to problems with antigen recognition, the appearance of autoantigens, which then mediates the immune response, the formation of autoantibodies, the production of inflammatory cytokines and inflammatory mediators, and the production of bone destruction In fact, in this series of immune, inflammatory, and bone destruction processes, the specific physiopathology of the immune function links is still relatively vague, what we know so far is that the cells involved in this process are complex, immune cells such as macrophages, B cells, T cells, etc., as well as chondrocytes, osteoblasts, fibroblasts, etc. are involved in the disease process. Anti-rheumatic disease-modifying drugs, also known as disease-modifying anti-rheumatic drugs (DMARDs), are divided into synthetic anti-rheumatic drugs and biological anti-rheumatic disease-modifying drugs (biologics). Among synthetic antirheumatic disease-modifying drugs, immunosuppressants belong to the traditional class of drugs and are the main drugs. The role of immunosuppressants is to inhibit the proliferation of the above-mentioned immune cells, which are abnormally active in the disease process, and to interfere with the growth of cells and inhibit their functions, including through the binding of drug molecules to specific proteins on the cell surface. This serves to inhibit and regulate the immune function of the body, has an immunosuppressive and anti-inflammatory effect, inhibits the proliferation of abnormal immune cells, stops the development of inflammation and prevents bone destruction, thus achieving the goal of stopping the development of the rheumatoid disease process. Immunosuppressants often achieve therapeutic goals by interfering with the growth and function of immune cells, which have their own cycle of growth, so these drugs are also known as slow-acting drugs because of their slower onset of action compared to other drugs used to treat rheumatoid arthritis. These drugs are produced by chemical synthesis and are called synthetic anti-rheumatic course-altering drugs. Conventional immunosuppressants are not selective in their effects on cells, and have an effect on certain cells that grow metabolically normally, which is a source of side effects of immunosuppressants. In addition to the inhibitory function for immune cells, immunosuppressants also have an anti-inflammatory effect and stop bone destruction, which are actually therapeutic effects achieved by cellular inhibition. Therefore, general patients can treat rheumatoid with immunosuppressants only, while hormones, non-steroidal anti-inflammatory drugs, and most biologics, are required to be used together with immunosuppressants. Immunosuppressants are the mainstay of rheumatoid therapy and are the basic and currently conditioned core medications. However, immunosuppressants, starting with methotrexate, are not new drugs developed, but rather drugs for other diseases that were developed and applied to the treatment of rheumatoid after being found to have immunosuppressive effects in pharmacological studies. The more common hydroxychloroquine is a drug for malaria, salazosulfapyridine is a drug for enteritis, and cyclophosphamide and azathioprine, like methotrexate, are drugs for cancer. This often creates some misunderstandings for patients, such as doubts about the efficacy and concerns about side effects, etc. Clinical practice has proven that these drugs, when used in reasonable doses, not only become good control agents for rheumatoid conditions, but also are not comparable to the treatment of diseases such as the original cancer in terms of toxic side effects. In the past decade or so, immunosuppressive therapy has undergone great changes and achieved good therapeutic efficacy. The emergence of leflunomide, the first specifically developed for rheumatoid, the development of thalidomide, which inhibits the proliferative effect of vascular opacification, and the development of small molecule drugs have led to an increase in the selection of drugs for rheumatoid treatment. In terms of clinical practice, the principles of immunosuppressive therapy have also been gradually improved and standardized treatment principles have been proposed. Specifically, they include: early use; combination use; full dosage and full course of use; personalized treatment, etc., which makes the treatment of immunosuppressive drugs more and more reliable. It can be said that, because of the use of immunosuppressive drugs, the treatment of rheumatoid disease has undergone a qualitative change. Rheumatoid is no longer a disease that makes people talk about it, and it means disability if you have rheumatoid, and it is called the “undead cancer”. In clinical use, methotrexate, which inhibits the synthesis of folic acid, is most commonly used in the early treatment of patients with moderate to severe RA, and it is the earliest and most widely used drug in clinical practice, and has been designated as the gold standard. The effects of leflunomide are comparable to those of methotrexate. Hydroxychloroquine is generally more commonly used in systemic lupus erythematosus, in undiagnosed but present immune indicators such as antinuclear antibodies, in undifferentiated immune diseases, and is an immunosuppressant that can be used during pregnancy for rheumatoid diseases. Sulfasalazine, more commonly used in the treatment of ankylosing spondylitis. Cyclophosphamide is commonly used to treat severe lupus erythematosus. Lyuzosulfapyridine, injectable gold preparations, and hydroxychloroquine do not have the same long-lasting effects as methotrexate. These drugs can be used in certain clinical situations or in combination with other drugs. For example, salazosulfapyridine is also commonly used to control mild to moderate disease activity and, like methotrexate, to relieve symptoms and slow joint damage. Cyclosporine, azathioprine, injectable gold preparations, and penicillamine have all been shown to be effective, but their use is limited by toxic effects and risk/benefit ratios. Hydroxychloroquine and minotetracycline are mainly used in the treatment of milder patients. Immunosuppressants have certain cytotoxic effects, side effects and efficacy, with homologous nature. Common manifestations are bone marrow suppression, hair loss, and organ damage such as liver and kidney. The main side effects of methotrexate are liver fibrosis, cirrhosis and interstitial lung fibrosis. Regularly check liver function, blood and urine routine, and adjust MTX dosage according to the test results. Leflunomide has a long half-life, and once the toxic reaction occurs, the use of abciximide can accelerate its excretion from the body. In the treatment of rheumatoid rheumatism, it is not a question of “whether to use immunosuppressants or not”, but “how to use immunosuppressants well”. Because immunosuppressants generally have toxic side effects, which is the reason why some patients resist immunosuppressants, or do not regulate the use of immunosuppressants. Patients who resist, refuse to use; patients who do not regulate the use, or low dose use, or as soon as possible, their own drug reduction, discontinuation; or self-selected immunosuppressant treatment, the use of immunosuppressant treatment misconceptions, often may cause delay in treatment, delay the disease, so that the development of rheumatoid rheumatism is not effectively controlled, increasing the difficulty of treatment. Different immunosuppressants, with their different mechanisms of action, for different links to play a role, we rheumatoid patients in getting this type of drugs, drug instructions can be more understandable and focused on speaking clearly, we patients generally do not need to do their own various extrapolations, especially in terms of side effects imagined. How to develop a treatment plan is something that professional doctors do, and it is our patients’ business to follow medical advice.