Ann Rheum Dis doi:10.1136/annrheumdis-2012-202737
  • Letter

Changing sulphasalazine to methotrexate does not improve the 2-year outcomes of the initial single DMARD treatment in early rheumatoid arthritis: subanalysis of the FIN-RACo trial

  1. for the FIN-RACo Trial Group
  1. 1Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
  2. 2Unit of Primary Health Care, Helsinki University Central Hospital and Department of General Practice, University of Helsinki, Helsinki, Finland
  3. 3Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
  4. 4Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
  5. 5Department of Rheumatology, University of Turku and Turku University Hospital, Turku, Finland
  1. Correspondence to Dr Vappu Rantalaiho, Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, PO BOX 2000, Tampere FI-33521, Finland; vappu.rantalaiho{at}
  • Received 26 September 2012
  • Revised 17 December 2012
  • Accepted 29 December 2012
  • Published Online First 24 January 2013

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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