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Correspondence response
Step-up therapy remains an appropriate option
  1. Duncan R Porter
  1. Correspondence to Dr Duncan R Porter, Institute of Infection, Immunity and Inflammation, University of Glasgow, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK; duncan.porter{at}glasgow.ac.uk

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I congratulate the research team from Rotterdam for the high-quality study design of the treatment in the Rotterdam Early Arthritis Cohort (tREACH) study, but their conclusions are overstated.1 Their quotation of the literature is incomplete, referring to some studies of initial combination disease-modifying antirheumatic drugs (DMARDs) plus corticosteroid (BeSt, FinRACo, COBRA trial) but excluding some other studies that do not support their conclusions. There have been two previously published randomised controlled trials comparing the step-up and initial combination triple DMARD therapy, which show no sustained benefit of the initial …

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