Drug therapy of rheumatoid arthritis in the elderly depends on the severity of the disease. Mild cases, which are usually of late onset and seronegative for rheumatoid factor, may respond to nonsteroidal anti-inflammatory drugs (NSAIDs), low dosages of corticosteroids, or hydroxychloroquine. Patients with more severe disease usually need the addition of remittive agents such as methotrexate, gold or sulfasalazine. Patients with longer duration of the disease (earlier onset) frequently have refractory rheumatoid arthritis and may need combination therapy with multiple remittive agents. All medications for the treatment of rheumatoid arthritis are potentially toxic. The agents with the best efficacy/toxicity ratios appear to be methotrexate, hydroxychloroquine and sulfasalazine. The drug therapy of rheumatoid arthritis requires a delicate balance of risk and benefit. The treating physician should be familiar with the nature of the disease and with the currently available medications.