OBJECTIVES: To assess current patient unmet needs in rheumatoid arthritis (RA) treatment by exploring patient experiences with biologics, including satisfaction, preference, and reasons for non-adherence and discontinuation. METHODS: In August 2009, 2,118 patients aged ≥18 and self-reporting an RA diagnosis completed a cross-sectional, self-administered, Internet-based questionnaire. Patients provided information about current and past use of biologic medication, treatment satisfaction (satisfied defined as 4 or 5 on a 5-point scale from 1=not at all satisfied to 5=extremely satisfied), preference for dosing frequency (less frequent dosing = every month or less often and more frequent dosing = two or more doses per month), adherence and reasons for non-adherence, and reasons for discontinuation of biologic agents in the twelve months preceding the study. RESULTS: 571 (27%) patients had experience with biologic therapy. Of these, 45% were currently using their first biologic, 29% had switched biologics and 27% used biologic therapy anytime in the past, but since discontinued. Among current biologic users, 63% were satisfied with their current therapy; however, among those who previously switched or discontinued, only 56% and 50%, respectively, were satisfied with current therapy. Of current biologic users, 72% preferred less frequent dosing of biologic medication and 28% preferred more frequent dosing.  Among patients who stopped using a subcutaneous biologic in the year preceding the study (n=62), whether switching to another biologic or discontinuing altogether, reasons for stopping included, doctors advice (42%), lack of efficacy (37%), side effects or infection (37%), medication cost (18%), and discomfort with administering (15%) . CONCLUSIONS: From the patient perspective, there are remaining unmet needs related to efficacy and tolerability with biologic therapy.  Furthermore, most patients showed preference for longer dosing intervals. Newer treatment options may address some of these unmet needs.  The patient perspective should be considered when making access decisions about newer biologic therapies.