الفهرس 
Traditional DMARDsOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is a chronic disease leading to severe disability and premature death. Combination therapy of disease modifying anti-rheumatic drugs (DMARDs) results in better outcomes in patients with early RA than does with single DMARD. The aim of this essay is to present a review about the value of combination of DMARDs in the treatment of RA. There were different strategies in the use of combination therapy (step-down approach, step-up approach, and parallel approach). A step-down treatment strategy for early RA is more effective than a step-up approach. Methotrexate has been the anchor drug in all successful combination trials. It has been used in combination with other traditional and biological DMARDs. Other combinations not included MTX were evaluated in clinical trials. In conclusion, patients with RA who are resistant to monotherapy are candidates for combination therapy. Monotherapy may alter the clinical course of the disease but complete remission is rare and the process of joint destruction continues in many patients. And generally, combination therapy is well tolerated and associated with no significant increase in the rate of adverse events compared with monotherapy.