What is early, aggressive treatment for ra?

Early is best. The idea is to get the arthritis under control before irreversible joint damage occurs. Sometimes thinking of an avalache is a good analogy. If you stop it at the top of the hill it is just a snowball, but if you wait until it gets to the bottom it is very destructive. For many patients there is a window of opportunity to completely halt the disease while it is still early.
Use of DMARDS. The sooner RA is diagnosed and treated the better the outcome. Usually an early aggressive treatment approach consists of Methotrexate alone or in combination with other medications. The choice depends on many factors including patient preference. In the us, a biologic treatment such as Enbrel (etanercept) or Humira are added to Methotrexate if Methotrexate alone is not enough to control your symptoms.
If you meet criteria. If you meet criteria for its use---high das28 score, erosions at baseline, etc the answer would be Methotrexate plus a biologic drug. However; not all patients meet this criteria at baseline.