Combining sulphasalazine and methotrexate in rheumatoid arthritis: early clinical impressions.

The use of combinations of second line antirheumatic agents (SLAs) is increasing. There are several reasons for combination therapy, e.g. the unsatisfactory effects of single therapy. Strategies for combining SLAs are to begin with combinations, or to add one or more agents to another. The strategy of adding one agent to another is illustrated by a study of 40 patients having insufficient effect from sulphasalazine (SASP). Patients were randomized between methotrexate (MTX) and the combination of SASP and MTX. The patients were evaluated by a single observer in an open design. The follow-up was 24 weeks. The mean decrease in disease activity score was significantly greater and occurred earlier in the combination group. This favourable response was also present in the other efficacy variables. The incidence of toxicity was equal in both groups. These results support the strategy of adding MTX to SASP when combining these second line antirheumatic drugs.