title: The usefulness of a new triple combination treatment utilizing methotrexate, salazosulfapyridine, and bucillamine in rheumatoid arthritis.
abstract: OBJECTIVE
  Combination treatment with methotrexate, salazosulfapyridine and bucillamine as an alternative to treatment with TNF-inhibiting biologics in rheumatoid arthritis was investigated.
  
  
  METHODS
  Twenty-six facilities allied with the Japan Association of Rheumatologists in Private Practice participated in this study. One hundred and twelve patients enrolled in this study, all of whom were within 3 years of diagnosis with rheumatoid arthritis for whom treatment with one DMARD or a combination of two DMARDs had failed (DAS28 > 3.2). Patients chose their own treatment. The triple DMARDs combination group was comprised of 72 patients; the TNF-inhibiting biologics treatment group was comprised of 40 patients.
  
  
  RESULTS
  DAS28 scores for the triple DMARDs combination group and the TNF-inhibiting biologics treatment groups were 4.84 ± 0.96 and 5.23 ± 1.26, and there was no significant difference between the two groups. From the 6th month, average disease activities of both groups were reduced, and there was no difference between the two groups at 12 months (DAS28, 3.39 ± 1.43 and 3.05 ± 1.43, p = 0.39). Furthermore, there was no significant difference in the degree of bone destruction between the two groups at 12 months.
  
  
  CONCLUSIONS
  The triple DMARD combination therapy provided a new treatment option for those patients for whom treatment with biologics is difficult.
authors.affiliation: a Matsuno Clinic for Rheumatic Diseases , Toyama , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuno
authors.affiliation: b Immuno-Rheumatology Center, St. Luke's International Hospital , Tokyo , Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Okada
authors.affiliation: c Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: d Abe Clinic , Tokyo , Japan.
authors.forename: Chiyuki
authors.initials: C
authors.lastname: Abe
authors.affiliation: e Katayama Orthopedic Rheumatology Clinic , Toyooka, Asahikawa , Japan.
authors.forename: Kou
authors.initials: K
authors.lastname: Katayama
authors.affiliation: f Sagawa Akira Rheumatology Clinic , Sapporo , Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sagawa
authors.affiliation: g Shin Yokohama Yamasaki Clinic , Yokohama , Japan.
authors.forename: Kuniomi
authors.initials: K
authors.lastname: Yamasaki
authors.affiliation: h Kondo Clinic of Rheumatology and Orthopaedic Surgery , Fukuoka , Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kondo
authors.affiliation: i Kansetsu Saisei Kenkyujo , Kobe , Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Funahashi
authors.affiliation: j Matsubara Mayflower Hospital , Kato , Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D003545:Cysteine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012460:Sulfasalazine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D012460:Sulfasalazine; D003545:Cysteine; C026535:bucillamine; D008727:Methotrexate
keywords: Antirheumatic agents; Bucillamine; Methotrexate; Rheumatoid arthritis; Sulfasalazine