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Complcations and isadvantages of Joint-sacrificing Procedures esection arthroplasty of the MTP joints An unpleasant cosmetic appearance Higher risk of recurrence of deformity and metatarsalagiaA Paradigm Shift in the Treatment of RA NSAIDs Reduce disease activty DMARDs(MTX)+1st Generation biologic agents Clincal remission Imaging remission DMARDs(MTX)+2nd Generation biologic agents True remission.