title: Combination therapy versus monotherapy for the treatment of patients with rheumatoid arthritis.
abstract: OBJECTIVE
  The response to single disease modifying antirheumatic drug (DMARD) is often suboptimal in patients with rheumatoid arthritis (RA). Thus, despite the limited data on the therapeutic efficacy of combination therapies, many patients are currently treated with a combination of DMARDs.
  
  
  METHODS
  We studied prospectively the efficacy of combination therapy with DMARDs. The study was designed as a randomized trial and a single DMARD or two or three DMARD combinations were administered to 180 consecutive, age- and sex-matched patients with active RA, each of whom was followed up for a period of 2 years under treatment. Patients were divided into 3 groups which did not differ with regard to demographic, clinical and laboratory parameters. Patients in group I were treated with a single DMARD [methotrexate (MTX) 7.5-15 mg/week or sulfasalazine (SSZ) 1-2 g/day or hydroxychloroquine (HCQ) 200 mg/day], group II with MTX + SSZ or MTX + HCQ, and group III with a combination of all three drugs. Patients were re-evaluated at regular intervals by means of clinical and biochemical tests designed to detect specific rheumatic activity. Radiological assessments were also performed and scored according to Larsen by the same radiologist who was blinded to the treatment groups.
  
  
  RESULTS
  At the end of the trial there were significant improvements in the clinical and laboratory parameters in all 3 groups. However, improvements were greater and much more significant in the patients who were given combination therapies. The combination of MTX + SSZ + HCQ was more effective than both monotherapy and the two-drug combinations.
  
  
  CONCLUSIONS
  In conclusion, we suggest that patients with RA should be treated with combinations of DMARDs.
authors.affiliation: Hacettepe University School of Medicine, Department of Rheumatology, Ankara, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Calgüneri
authors.forename: S
authors.initials: S
authors.lastname: Pay
authors.forename: Z
authors.initials: Z
authors.lastname: Calişkaner
authors.forename: S
authors.initials: S
authors.lastname: Apraş
authors.forename: S
authors.initials: S
authors.lastname: Kiraz
authors.forename: I
authors.initials: I
authors.lastname: Ertenli
authors.forename: V
authors.initials: V
authors.lastname: Cobankara
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001175:Arthrography; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012460:Sulfasalazine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D008727:Methotrexate