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Rheumatology Advance Access originally published online on June 29, 2004
Rheumatology 2004 43(10):1205-1207; doi:10.1093/rheumatology/keh299
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Rheumatology Vol. 43 No. 10 © British Society for Rheumatology 2004; all rights reserved

Editorial

Two is better than one? Combination therapy in rheumatoid arthritis

E. H. Choy

Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of Rheumatology, GKT School of Medicine, King's College London, UK

Correspondence to: E. Choy, Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of Rheumatology, 2nd Floor, Weston Education Centre, King's College London, Cutcombe Road, London SE5 9PJ, UK. E-mail: ernest.choy@kcl.ac.uk

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Treatment for rheumatoid arthritis (RA) has changed considerably over the last 20 yr. Gone are the days when treatment was based on the pyramid approach. Instead, patients with RA are now started on disease-modifying anti-rheumatic drugs (DMARDs) once the diagnosis is established. Although DMARD monotherapy reduces inflammation, disease remission is uncommon. Consequently they do not arrest joint damage completely, although the rate of progression is reduced. In cross-sectional studies, the percentage of patients with RA in disease remission, as defined by the 1981 American Rheumatology Association preliminary criteria, is less than 10% [1]. In longitudinal studies, 30–40% of patients experience remission some time during their disease but persistent remission is uncommon [2]. The limitations of DMARD monotherapy prompted the search for more effective treatment strategies.

Combining two or more DMARDs to treat patients with RA is not a new idea. The first report was published over . . . [Full Text of this Article]


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