Thank you for the query. There are certain information missing from the information you have provided. I would like to know your age, gender, duration of Rheumatoid arthritis, the drug regimen (if any) that you are following and your disease activity at present. First and foremost, I would ask how were you diagnosed with RA? Was the RA factor positive, or was the anti CCP positive or both? To know the disease activity, clinical markers (like joint tenderness, redness, swelling) and laboratory inflammatory markers (like ESR and CRP) are important. For the acute attacks, steroids and painkillers are used, whereas for long term (to prevent joint deformity and to lower the disease activity), DMARDs (disease modifying anti-rheumatic drugs) are used. DMARDs consist of Methotrexate, Hydrochloroquine, Sulfasalazine, Leflunomide etc. Presently, the norm is to start with Methotrexate (if no contraindications are noted). These drugs can be given in various combinations. These drugs have a number of side effects, which need to be monitored from time to time. Usually, when RA disease activity is not controlled with 3 DMARDs, then biologicals (like Infliximab, Etanercept, Adalimumab), can be added. These drugs are very expensive. Biologicals are contraindicated in active and latent TB (as in your case Quantiferon TB Gold is positive), and they may cause a flare of underlying TB. Physiotherapy and rehabilitation has a role in the management. As I have mentioned above, active disease can be established clinically (by examining the joints), laboratory (raised ESR/CRP) and radiologically (peritarticular erosions noted). Hope this helps you out. Regards, Dr. Ayusmati Thakur