COMBINATION THERAPY IN RHEUMATOID-ARTHRITIS - UPDATED SYSTEMATIC REVIEW

In a second update of a systematic review, many new developments in th e combined drug treatment of rheumatoid arthritis (RA) are highlighted . In early RA patients, step-down bridge therapy that includes cortico steroids leads to much enhanced efficacy at acceptable or low toxicity . The effects on joint damage may be persistent, but the symptomatic e ffects are probably dependent on continued corticosteroid dosing. In l ate patients, cyclosporin improves a suboptimal clinical response to m ethotrexate, and the triple combination of methotrexate, sulphasalazin e and hydroxychloroquine appears to be clinically better than the comp onents. Other combinations are either untested, tested at low sample s ize, or show negative interaction. In view of the low volume of eviden ce, most studies need confirmation by replication.