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The current treatment of rheumatoid arthritis (RA) aims at early and sustained remission.1 However, the opinions on how to reach this target vary. The European guideline recommends the use of initial methotrexate (MTX), and if that fails, adding a biologic. A combination of disease modifying antirheumatic drugs (DMARDs) is not seen as an option as initial therapy or as the next step in patients with active RA failing MTX.2 Others have, however, included combination DMARDs in the first and second line treatment recommendations,3 ,4 and the Finns, thanks to the encouraging results and comprehensive national participation in the FIN-RACo trial,5 even propose triple DMARD combination as the initial treatment in active early RA.6 Direct comparisons between combination therapy and single MTX have been lacking; until recently, the tREACH trial fulfilled this gap by confirming the superiority of triple combination compared with single MTX in early RA.7
The FIN-RACo trial proved that the initial triple DMARD combination (MTX, sulphasalazine (SASP) and hydroxychloroquine) is superior to single DMARD therapy, started with SASP, which, however, could be …
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