THE CYCLING OF COMBINATION ANTIRHEUMATIC DRUG THERAPY IN RHEUMATOID ARTHRITIS

In this open pilot study a combination of hydroxychioroquine,prednisolone and alternating months of treatment with sulphasalazineor oral weekly pulse methotrexate has been investigated in 16patients with rheumatoid arthritis (RA) refractory to a totalof 67 disease suppressive medications. Results at 3 months indicatedsignificant improvements in visual analogue score for pain,joint count, Ritchie index, scale of disability related to activitiesof daily living, ESR, rheumatoid factor and C-reactive protein.This degree of improvement, however, was not maintained 6 and12 months after commencement of treatment. Pain score, Ritchieindex and ESR were the only parameters demonstrating significantimprovement at 12 months. Therapy was terminated in eight patients,half due to lack of efficacy and half because of side effects. KEY WORDS: Arthritis, Treatment, Methotrexate, Sulphasalazine, Antimalarials, Corticosteroids