Additive triple DMARD combination therapy of a low dose of sulfhydryl compounds, sulfasalazine and methotrexate in the treatment of rheumatoid arthritis: A clinical trial

To evaluate the efficacy and safety of additive triple disease modifying an ti-rheumatic drug (DMARD) combination therapy of a low dose of sulfhydryl c ompounds {D-penicillamine, bucillamine or tiopronin}, sulfasalazine (SSZ) a nd methotrexate (MTX) as a treatment for rheumatoid arthritis (RA) patients , we studied a total of 33 Japanese RA patients (6 males, 27 females). At 1 or 2 months after simultaneous administration of the 3 above-mentioned DMA RDs was begun, significant improvements were seen in markers of joint infla mmation, i.e., erythrocyte sedimentation rate and C-reactive protein in ser a. At 6 months, clinical improvement judged by the physicians' overall asse ssment of joint symptoms and laboratory data was observed in 29 (88%) of th e 33 RA patients. No marked effect was observed in the other 4(12%) patient s, however. We observed no significant adverse reaction to this therapy. Th is suggests that additive triple DMARD combination therapy of a low dose of sulfhydryl compounds, SSZ and MTX could be a useful drug therapy for the t reatment of RA patients, even those who are refractory.