Back to the future: the pyramids of rheumatoid arthritis.

The management treatment pyramid, treatment target and treatment pyramids provide a framework for RA management and treatment. This model brings back the traditional pyramid, which was widely accepted, and adapts it to our newer understanding of RA treatment. It provides a focus for care, as well as the flexibility to apply selective treatments to different temperaments of disease. We hope that these models will fill the void left by the abandonment of the traditional pyramid. We certainly need a model to refocus the patient and physician to the importance of RA and bring "order out of chaos". With our current knowledge, resources, and drugs, we could be making a far greater impact on this serious, expensive, and crippling disease. We must re-excite and re-educate the public, the patient, and the profession to the remarkable progress we have made with incurable but very treatable arthritis.