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Prof Peter Taylor opened the symposium focussed on optimisation of treatment for rheumatoid arthritis (RA) at each stage of the patient’s journey. Prof Ronald van Vollenhoven reviewed the evidence for first- line biologics in the ‘exceptional patient’ and explored which patients may be suitable for such treatments. Prof Taylor then expanded on how use of such treatments could be optimised and when to introduce biologic therapy for the so-called ‘standard’ patient. Finally, Prof Daniel Aletaha discussed treatment options and targets for patients who have failed on a biologic as ‘the rule’ in the treatment of RA.