Rheumatoid arthritis (RA) affects approximately 0.5% of adult Indian population. The last few decades have seen significant advances in the treatment of RA. Pari-pasu, the goals of treatment have moved from symptomatic relief and disease modification to remission and even possible cure. One major hurdle in providing effective therapy is the high cost of medications. In a developing country like ours, cost-effective management of RA patients becomes an important issue. Paucity of trained rheumatologists, poverty, inaccessibility etc. are added hurdles in the delivery of cost-effective treatment. This communication is an overview of the various issues and the possible ways to address them.