title: [Combination therapy in rheumatoid arthritis].
abstract: 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.
authors.affiliation: Revmatologisk avdeling, Sørlandet sykehus, 4604 Kristiansand. villy.johnsen@sshf.no
authors.forename: Villy
authors.initials: V
authors.lastname: Johnsen
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Førre
authors.forename: Hans-Jacob
authors.initials: HJ
authors.lastname: Haga
authors.forename: Tore Kristian
authors.initials: TK
authors.lastname: Kvien
authors.forename: Knut
authors.initials: K
authors.lastname: Mikkelsen
authors.forename: Bjørn-Yngvar
authors.initials: BY
authors.lastname: Nordvåg
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
mesh_terms: 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
chemical_list: D000276:Adjuvants, Immunologic; D018501:Antirheumatic Agents; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D016572:Cyclosporine; D008727:Methotrexate