Rheumatoid arthritis treatment increasingly aims for rapid disease control and sustained remission, particularly early in the disease course. The SELECT-EARLY phase 3 trial compared once-daily upadacitinib with methotrexate in patients who were methotrexate-naïve or had only limited prior exposure. The randomized design assessed both clinical response and achievement of low disease activity or remission. The study showed that upadacitinib produced robust improvements in disease activity and joint symptoms, demonstrating the efficacy of selective JAK1 inhibition as an early treatment option. For orthopaedic clinicians, the relevance extends beyond rheumatology because uncontrolled inflammatory activity affects pain, function, bone quality and perioperative risk. The trial also highlights the importance of coordinating medication decisions around surgery rather than stopping or continuing immunomodulatory therapy without a plan. Upadacitinib is not a risk-free therapy, and treatment choice must incorporate infection risk, cardiovascular and thrombotic considerations, age and patient-specific factors. The key clinical message is therefore not “use upadacitinib for everyone,” but that targeted therapy can provide rapid disease control when conventional treatment alone is inadequate or when a targeted approach is appropriate. Multidisciplinary communication remains essential when these patients undergo orthopaedic procedures.