Rheumatoid arthritis (RA) is a common chronic inflammatory disease associated with progressive destruction of diarthrodial joints, substantial morbidity and economic burden, and a shortened lifespan. Significant progress has been made in understanding the pathogenesis of RA, and increasingly effective therapies have been introduced, including anti-tumor necrosis factor alpha agents. Advances made in the past quarter century will pale in comparison to those anticipated for the next 25 years, including delineation of the genetic basis of disease susceptibility and severity, genetic definition of disease subtypes that differ in severity and response to therapy, and prompt initiation of effective individualized treatment based on genetic and environmental assessment. Reconstructive surgery will become increasingly unnecessary and the morbidity, economic burden, and mortality due to RA will be reduced substantially.