Rheumatic diseases are common, serious conditions characterized by alterations in normal immune homeostasis with resultant end-organ injury. Although diverse in clinical expression and pathophysiologic basis, therapeutic approaches for these conditions frequently overlap. Over the past decade, several important new therapies have been introduced into the clinic for the treatment of many rheumatic conditions. Although these agents have proven highly effective, their higher costs have raised questions concerning their most appropriate use in the clinic. This issue has been analyzed in greatest detail in rheumatoid arthritis. Increasing data suggest that newer therapeutics may be cost-effective for rheumatoid arthritis and other rheumatic diseases.