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Development of new therapies to treat rheumatoid arthritis (RA) shows no sign of waning. It is essential that studies are well designed, meticulously planned, include ongoing data surveillance and have a well-orchestrated patient recruitment strategy. It truly is a case of survival of the fittest - investigators will typically sway towards studies that not only offer their patients access to the newest therapies but which are the easiest to participate in, with minimal additional patient and site staff burden.