OBJECTIVES:  Many studies have investigated socioeconomic and cost issues in rheumatoid arthritis (RA); the introduction of TNF blockers and other biological therapies since 2000 has proven efficacy, and however it has been associated with high costs compared with established DMARDs. The aim of this study was to analyze the health costs of RA therapy and the effectiveness of therapy evaluated by DAS28 over a 5 year period from the perspective of the health care system. METHODS:  The data of this study was taken from a registry in a RA specialized center in Colombia. We selected patients who had moderate/severe disease activity and had a minimum of 12 follow visits during 2012-2016. These patients were followed-up under strictly T2T standards. Clinical follow-up was done according to DAS28. Therapy had to be adjusted with DAS28 > 3.2 unless patient´s conditions don’t permit it. The cost analysis was made considering the cost of medications, consultation with a multidisciplinary team, laboratory and radiological tests. The effectiveness was measured by improvement in DAS28. RESULTS: Between 2012 and 2016 1220 patients meet the inclusion criteria, 83% were female, mean age was 62 ± 10. 776 patients were receiving conventional DMARDs and 444 biological therapies; DAS28 average was 4.5 ±1.0 at beginning; after 5 years 864 patients achieved remission/low disease activity: 70% were receiving DMARDs and 30% biological therapy. The average year costs of therapy during 5 years in order to achieve remission/LDA in the group receiving DMARDs was $423.313 US dollars, while the average costs to achieve remission/LDA in the group receiving biological therapy was $2.392.197 US dollars. CONCLUSIONS:  The results of this registry shows that conventional DMARDs therapy can achieve remission/LDA at a considerably lower costs compared to biological therapy (five/six times) saving costs for the health system over the years.