Two is better than one? Combination therapy in rheumatoid arthritis

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Abstract
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.

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