Is rheumatoid arthritis really getting less severe?

The incidence of rheumatoid arthritis (RA) is decreasing, and rheumatologists perceive that their patients are presenting with less-disabling disease. This impression coincides with the availability of improved therapeutic options, including biologic agents. In RA, the term 'disease severity' can be defined from various perspectives: that of the patient, or by measures of disease activity and damage. This Perspectives article examines the scientific basis for a perceived decrease in RA severity over time, as determined by patient-reported outcomes and measures of disease severity and structural damage. An improved health care system and better treatment strategies with access to new therapeutic modalities are likely to have contributed to a milder RA disease course in more-recent years. The focus needs to be kept on these issues to further improve disease severity in patients with RA.