[Combination therapy in rheumatoid arthritis].
BACKGROUND
During the last decade patients with active rheumatoid arthritis have been offered early and aggressive drug therapy in order to decrease the damaging effect of inflammation on cartilage and bone. Combination of two or more disease-modifying antirheumatic drugs has been used more frequently to achieve better efficacy than with monotherapy without increasing drug side effects.


METHODS
We have studied available rheumatological literature to find the best documented drug combinations.


RESULTS
The combination of methotrexate, sulfasalazine and hydroxychloroquine seems to be a well documented alternative, and so is the combination of methotrexate and cyclosporine. Modern biologic drugs like etanercept, infliximab and anakinra work best in combination with methotrexate.


CONCLUSIONS
The combination of two or more disease-modifying antirheumatic drugs can be a good alternative to monotherapy in the treatment of patients with active rheumatoid arthritis, either when monotherapy has failed or unacceptable side effects have occurred, or as a first choice in patients who need very early and aggressive therapy. Combination therapy should only be initiated by a rheumatologist, after informed consent. A safe clinical and chemical monitoring must be organized in cooperation with the patient and the primary physician.
Johnsen
Villy
V
Revmatologisk avdeling, Sørlandet sykehus, 4604 Kristiansand. villy.johnsen@sshf.no
Førre
Øystein
Ø
Haga
Hans-Jacob
HJ
Kvien
Tore Kristian
TK
Mikkelsen
Knut
K
Nordvåg
Bjørn-Yngvar
BY
Rødevand
Erik
E
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D012460:Sulfasalazine / Q000008:administration & dosage / Q000009:adverse effects
D000276:Adjuvants, Immunologic; D018501:Antirheumatic Agents; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D016572:Cyclosporine; D008727:Methotrexate