Tumour necrosis factor (TNF-α) inhibitors have improved the clinical outcome of many patients with rheumatoid arthritis (RA). However, some patients do not respond well or have contraindications to these agents. The appropriate treatment strategy in refractory RA would be possible by optimizing concomitant conventional disease modifying antirheumatic drugs, increasing the dose of TNF-α inhibitor or shortening the dosing frequency, switching to another TNF-α inhibitor or switching to other new biological agents available for use in patients with RA such as abatacept or rituximab.