Jack, re new DMARDs and increased switching, I have often seen rheumatoids in good remission who have a "brief" flare which I can overcome with a short steroid taper (< 10 days), returning to excellent low disease activity for long periods. Before many options were available, this was a good strategy. Now, with many DMARD options, the ":flare" is more likely to result in a switch of DMARDs or MOA. This may misrepresent the value of the original DMARD and also remove that DMARD as a viable choice for future use- when a simple steroid taper may have resulted in greater longevity of the original DMARD.