Combination therapy in early rheumatoid arthritis.

The course of rheumatoid arthritis (RA) is determined early and the goals in early RA are to prevent radiologic joint degradation and to achieve optimal clinical and biological remission. Achieving these goals means that many RA patients may be candidates for combination disease-modifying therapy. We review data from randomized clinical trials regarding the impact of these treatment strategies as the initial therapy in early RA. It appears likely that the place of combination therapy will increase in the coming decades, even in very early RA patients, where the ultimate goal is persistent remission.