Author’s reply: Combination DMARD therapy for rheumatoid arthritis. Full or low DMARD doses?

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Abstract
We read with great interest the paper by O’Dell.1We would like to offer some comments on it. Although we strongly believe in the rationale of the author, we feel that as clinicians our options should be based on clear cut data when treating patients with erosive progressive rheumatoid disease. In our clinical practice, in active and severe diseases, we try to optimise any treatment by using the highest doses of both non-steroidal anti-inflammatory drugs and disease modifying antirheumatic drugs (DMARDs), compatible with an acceptable risk of toxicity. According to the medical literature, in rheumatoid arthritis (RA) the highest doses of OH-chloroquine (OH-C) are 6 mg/kg/day, of methotrexate (MTX) 17.5-20 mg/week, and of sulphasalazine 3 g/day.2-4 Poor or inadequate responses can be assessed only when these amounts are reached. In the study by O’Dell,5 three groups of patients were studied, one receiving full doses of MTX, one a combination of full doses of OH-C and 1 g/day sulphasalazine, and the third a combination of the three. To our knowledge no data exist suggesting that the …