Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a Combination of All Three Medications

Rheumatoid arthritis is a common disease 1 that causes substantial morbidity in most patients 2 and premature mortality in many. 2 – 4 Conventional therapy for rheumatoid arthritis includes the administration of antiinflammatory drugs, followed by disease-modifying antirheumatic drugs such as methotrexate, hydroxychloroquine, sulfasalazine, and gold in patients with persistent active disease. Short-term studies 5 – 14 and meta-analyses 15 , 16 have repeatedly proved the efficacy of disease-modifying drugs, but their long-term effectiveness is less than optimal; therefore, most patients do not take them for more than two to five years, 17 , 18 because of either lack of efficacy or toxic effects. Patients treated with methotrexate have the . . .