Calgüneri M, Pay S, Calişkaner Z, Apraş S, Kiraz S, Ertenli I, Cobankara V
Hacettepe University School of Medicine, Department of Rheumatology, Ankara, Turkey.
Clin Exp Rheumatol. 1999 Nov-Dec;17(6):699-704.
The response to single disease modifying antirheumatic drug (DMARD) is often suboptimal in patients with rheumatoid arthritis (RA). Thus, despite the limited data on the therapeutic efficacy of combination therapies, many patients are currently treated with a combination of DMARDs.
We studied prospectively the efficacy of combination therapy with DMARDs. The study was designed as a randomized trial and a single DMARD or two or three DMARD combinations were administered to 180 consecutive, age- and sex-matched patients with active RA, each of whom was followed up for a period of 2 years under treatment. Patients were divided into 3 groups which did not differ with regard to demographic, clinical and laboratory parameters. Patients in group I were treated with a single DMARD [methotrexate (MTX) 7.5-15 mg/week or sulfasalazine (SSZ) 1-2 g/day or hydroxychloroquine (HCQ) 200 mg/day], group II with MTX + SSZ or MTX + HCQ, and group III with a combination of all three drugs. Patients were re-evaluated at regular intervals by means of clinical and biochemical tests designed to detect specific rheumatic activity. Radiological assessments were also performed and scored according to Larsen by the same radiologist who was blinded to the treatment groups.
At the end of the trial there were significant improvements in the clinical and laboratory parameters in all 3 groups. However, improvements were greater and much more significant in the patients who were given combination therapies. The combination of MTX + SSZ + HCQ was more effective than both monotherapy and the two-drug combinations.
In conclusion, we suggest that patients with RA should be treated with combinations of DMARDs.
类风湿关节炎（RA）患者对单一改善病情抗风湿药（DMARD）的反应往往欠佳。因此，尽管联合治疗的疗效数据有限，但目前许多患者仍接受DMARD联合治疗。
我们前瞻性地研究了DMARD联合治疗的疗效。该研究设计为一项随机试验，将单一DMARD或两种或三种DMARD联合用药给予180例连续的、年龄和性别匹配的活动性RA患者，每位患者在治疗期间随访2年。患者被分为3组，在人口统计学、临床和实验室参数方面无差异。第一组患者接受单一DMARD治疗[甲氨蝶呤（MTX）7.5 - 15毫克/周或柳氮磺吡啶（SSZ）1 - 2克/天或羟氯喹（HCQ）200毫克/天]，第二组接受MTX + SSZ或MTX + HCQ治疗，第三组接受三种药物联合治疗。通过旨在检测特定风湿活动的临床和生化测试定期对患者进行重新评估。还进行了放射学评估，并由对治疗组不知情的同一位放射科医生根据拉森法进行评分。
试验结束时，所有3组的临床和实验室参数均有显著改善。然而，接受联合治疗的患者改善更大且更显著。MTX + SSZ + HCQ联合治疗比单药治疗和两药联合治疗更有效。
总之，我们建议RA患者应接受DMARD联合治疗。
