Maria Judd was involved in the design of the project, literature screening, data abstraction and interpretation for the clinical review, and writing of the report. [...] Peter Tugwell was involved in the design of the project, review of trials, and analysis; and provided input on drafts and revisions of the report. [...] Objective The objective of this study is to provide a clinical review and economic evaluation relating to the introduction of infliximab and etanercept to the sequence of DMARDs used in the treatment of RA. [...] The Sharp score is the sum of two scores that evaluate the presence and severity of erosions and joint space narrowing on a scale of zero to three and zero to four for. [...] The results of the survey confirmed MTX as the primary choice in the treatment of aggressive RA.