For patients with early rheumatoid arthritis (RA), starting therapy with a combination of disease-modifying antirheumatic drugs (DMARDs) improves long-term outcomes without an increase in adverse events. The combination of methotrexate, sulfasalazine, and hydroxychloroquine plus prednisolone is satisfactory for most patients.
Rantalaiho and associates monitored 199 patients with recent-onset RA who were randomized to a combination regimen or a single DMARD. After the first 2 years of treatment, patients could opt to change their DMARD regimen. To evaluate progress, the researchers used the Health Assessment Questionnaire (HAQ), modified Minimal Disease Activity (MDA) measure, and American College of Rheumatology (ACR) criteria for remission.
Patients taking multiple DMARDs had better long-term outcomes. At 11 years, 56% of the combination group versus 43% of the monotherapy group achieved an HAQ score of 0. Of patients taking multiple DMARDs, more than one-third—37%—met strict ACR criteria for improvement, a feat matched by only 19% of the patients taking 1 DMARD. The modified MDA criteria for improvement were met by 63% of the combination-group patients versus 43% of single-therapy patients.
The authors noted that the management of RA should consist of more than choosing among various DMARDs and should be guided by tight control.