Sulfasalazine: A review of its use in the management of rheumatoid arthritis

Drugs

Volumn 65, Issue 13, 2005, Pages 1825-1849

  Plosker, Greg L ^a   Croom, Katherine F ^a  

^a ADIS INTERNATIONAL LIMITED   (New Zealand)

Author keywords

Pharmacodynamics; Pharmacokinetics; Rheumatoid arthritis; Sulfasalazine; Therapeutic use

Indexed keywords

AURANOFIN; AUROTHIOMALATE; AZATHIOPRINE; CORTICOSTEROID; CYCLOPHOSPHAMIDE; CYCLOSPORIN; DISEASE MODIFYING ANTIRHEUMATIC DRUG; ETANERCEPT; GOLD; HYDROQUININE; HYDROXYCHLOROQUINE; INFLIXIMAB; INTERLEUKIN 1 RECEPTOR BLOCKING AGENT; LEFLUNOMIDE; MESALAZINE; METHOTREXATE; MINOCYCLINE; PAMIDRONIC ACID; PENICILLAMINE; SALAZOSULFAPYRIDINE; SULFAPYRIDINE;

ALOPECIA; ANOREXIA; ANTIINFLAMMATORY ACTIVITY; BLOOD DYSCRASIA; BONE MARROW SUPPRESSION; CENTRAL NERVOUS SYSTEM DISEASE; CLINICAL TRIAL; DIARRHEA; DIZZINESS; DRUG ABSORPTION; DRUG ACTIVITY; DRUG DISTRIBUTION; DRUG EFFICACY; DRUG ELIMINATION; DRUG FORMULATION; DRUG HALF LIFE; DRUG HYPERSENSITIVITY; DRUG METABOLISM; DRUG TOLERABILITY; DYSGEUSIA; DYSPEPSIA; DYSPNEA; FLU LIKE SYNDROME; GASTROINTESTINAL SYMPTOM; HEADACHE; HUMAN; IMMUNOMODULATION; INFECTION; INJECTION SITE REACTION; LEUKOPENIA; LIVER DYSFUNCTION; LIVER TOXICITY; LYMPHOPROLIFERATIVE DISEASE; META ANALYSIS; NAUSEA; NONHUMAN; PROTEINURIA; RASH; RETINA DISEASE; REVIEW; RHEUMATOID ARTHRITIS; STOMATITIS; TABLET; THROMBOCYTOPENIA; VOMITING;

ANTIRHEUMATIC AGENTS; ARTHRITIS, RHEUMATOID; HALF-LIFE; HUMANS; RANDOMIZED CONTROLLED TRIALS; SULFASALAZINE;

ANIMALIA; BACTERIA (MICROORGANISMS);

EID: 24344457766     PISSN: 00126667     EISSN: None     Source Type: Journal    
DOI: 10.2165/00003495-200565130-00008     Document Type: Review

References (101)

1. Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet 2001 Sep 15; 358: 903-11
2. American College of Rheumatology Subcommittee on Rheuma-toid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum 2002 Feb; 46: 328-46
3. Smedegård G, Björk J. Sulphasalazine: mechanism of action in rheumatoid arthritis. Br J Rheumatol 1995 Nov; 34 Suppl. 2: 7-15
4. Fujiwara M, Mitsui K, Yamamoto I. Inhibition of proliferative responses and interleukin 2 productions by salazosulfapyridine and its metabolites. Jpn J Pharmacol 1990; 54 (2): 121-31
5. Hashimoto J, Sato K, Higaki M, et al. The effects of antirheumatic drugs on the production of, and the responsiveness to cytokines (IL-1 and IL-6). Drug Eval 1991 May; 11 (3): 279-86
6. Kang BY, Chung SW, Im SY, et al. Sulfasalazine prevents T-helper 1 immune response by suppressing interleukin-12 production in macrophages. Immunology 1999 Sep; 98 (1): 98-103
7. Rodenburg RJ, Ganga A, van Lent PL, et al. The antiinflammatory drug sulfasalazine inhibits tumor necrosis factor alpha expression in macrophages by inducing apoptosis. Arthritis Rheum 2000 Sep; 43 (9): 1941-50
8. Hirohata S, Ohshima N, Yanagida T, et al. Regulation of human B cell function by sulfasalazine and its metabolites. Int Immunopharmacol 2002 Apr; 2 (5): 631-40
9. Comer SS, Jasin HE. In vitro immunomodulatory effects of sulfasalazine and its metabolites. J Rheumatol 1988 Apr; 15 (4): 580-6
10. Imai F, Suzuki T, Ishibashi T, et al. Effect of sulfasalazine on B cell hyperactivity in patients with rheumatoid arthritis. J Rheumatol 1994 Apr; 21 (4): 612-5
11. Fener P, Bannwarth B, Gillet P, et al. Influence of sulfasalazine on established collagen arthritis in rats. Clin Exp Rheumatol 1990; 8: 167-70
12. Yamazaki T, Miyai E, Shibata H, et al. Pharmacological studies of salazosulfapyridine (SASP) evaluation of anti-rheumatic action [in Japanese]. Pharmacometrics 1991; 41 (6): 563-74
13. Yamamoto I, Fujiwara M, Moriya K, et al. In vivo and in vitro suppression of the anti-DNA antibody production and improvement of autoimmune disease in NZB/W F1 and MRL/1 mice by salazosulfapyridine. Pharmacometrics 1991; 41 (6):591-6
14. Abe C, Miyazaki N, Arinishi M, et al. Effects of salazosulfapyridine on joint lesions in MRL/I mice. Int J Immunother 1991; 7 (1): 9-14
15. Danis VA, Franic GM, Rathjen DA, et al. Circulating cytokine levels in patients with rheumatoid arthritis: results of a double blind trial with sulphasalazine. Ann Rheum Dis 1992 Aug; 51 (8): 946-50
16. Volin MV, Harlow LA, Woods JM, et al. Treatment with sulfasalazine or sulfapyridine, but not 5-aminosalicyclic acid, inhibits basic fibroblast growth factor-induced endothelial cell chemotaxis. Arthritis Rheum 1999 Sep; 42 (9): 1927-35
17. Akahoshi T, Namai R, Sekiyama N, et al. Rapid induction of neutrophil apoptosis by sulfasalazine: implications of reactive oxygen species in the apoptotic process. J Leukoc Biol 1997 Dec; 62: 817-26
18. Pruzanski W, Stefanski E, Vadas P, et al. Inhibition of extracellular release of proinflammatory secretory phospholipase A2 (sPLA2) by sulfasalazine: a novel mechanism of anti-inflammatory activity. Biochem Pharmacol 1997 Jun 15; 53 (12): 1901-7
19. Gadangi P, Longaker M, Naime D, et al. The anti-inflammatory mechanism of sulfasalazine is related to adenosine release at inflammed sites. J Immunol 1996 Mar 1; 156: 1937-41
20. Matasic R, Dietz AB, Vuk-Pavlovic S. Maturation of human dendritic cells as sulfasalazine target. Croat Med J 2001 Aug; 42 (4): 440-5
21. Lee CK, Lee EY, Chung SM, et al. Effects of disease-modifying antirheumatic drugs and antiinflammatory cytokines on human osteoclastogenesis through interaction with receptor activator of nuclear factor kappaB, osteoprotegerin, and receptor activator of nuclear factor kappaB ligand. Arthritis Rheum 2004 Dec; 50 (12): 3831-43
22. Tett SE. Clinical pharmacokinetics of slow-acting antirheumatic drugs. Clin Pharmacokinet 1993 Nov; 25 (5): 392-407
23. Rains CP, Noble S, Faulds D. Sulfasalazine: a review of its pharmacological properties and therapeutic efficacy in the treatment of rheumatoid arthritis. Drugs 1995 Jul; 50: 137-56
24. Klotz U. Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid. Clin Pharmacokinet 1985; 10 (4): 285-302
25. Uchida E, Kai K, Kobayashi S, et al. A study of pharmacokinetics and safety of salazosulfapyridine enteric coated tablet (PJ-306) in healthy Japanese subjects [in Japanese]. Jpn J Clin Pharmacol Ther 1990 Jun; 21 (2): 377-89
26. Astbury C, Taggart AJ, Juby L, et al. Comparison of the single dose pharmacokinetics of sulphasalazine in rheumatoid arthritis and inflammatory bowel disease. Ann Rheum Dis 1990 Aug; 49 (8): 587-90
27. Pharmacia & Upjohn Company. Azulfidine EN-tabs® (sulfasalazine delayed release tablets, USP) prescribing information. Kalamazoo (MI): Pharmacia & Upjohn Company, 2001 Sep
28. Taggart AJ, McDermott B, Delargy M, et al. The pharmacokinetics of sulphasalazine in young and elderly patients with rheumatoid arthritis. Scand J Rheumatol Suppl 1987; 64: 29-36
29. Taggart AJ, McDermott BJ, Roberts SD. The effect of age and acetylator phenotype on the pharmacokinetics of sulfasalazine in patients with rheumatoid arthritis. Clin Pharmacokinet 1992 Oct; 23 (4): 311-20
30. Tanaka E, Taniguchi A, Urano W, et al. Adverse effects of sulfasalazine in patients with rheumatoid arthritis are associated with diplotype configuration at the N-acetyltransferase 2 gene. J Rheumatol 2002 Dec; 29: 2492-9
31. Ohtani T, Hiroi A, Sakurane M, et al. Slow acetylator genotypes as a possible risk factor for infectious mononucleosis-like rheusyndrome induced by salazosulfapyridine. Br J Dermatol 2003 May; 148 (5): 1035-9
32. Haagsma CJ, Russel FGM, Vree TB, et al. Combination of methotrexate and sulphasalazine in patients with rheumatoid arthritis: pharmacokinetic analysis and relationship to clinical response. Br J Clin Pharmacol 1996 Aug; 42: 195-200
33. Suarez-Almazor ME, Belseck E, Shea B, et al. Sulfasalazine for treating rheumatoid arthritis (review). Cochrane Database Syst Rev 2000; (2): CD000958
34. Ebringer R, Ahern M, Thomas D, et al., on behalf of the Australian Multicentre Clinical Trial Group. Sulfasalazine in early rheumatoid arthritis. J Rheumatol 1992; 19 (11): 1672-7
35. Farr M, Waterhouse L, Johnson AE, et al. A double-blind controlled study comparing sulphasalazine with placebo in rheumatoid factor (RF)-negative rheumatoid arthritis. Clin Rheumatol 1995 Sep; 14: 531-6
36. Hannonen P, Mottonen T, Hakola M, et al. Sulfasalazine in early rheumatoid arthritis: a 48-week double-blind, prospective, placebo-controlled study. Arthritis Rheum 1993 Nov; 36 (11): 1501-9
37. Williams HJ, Ward JR, Dahl SL, et al. A controlled trial comparing sulfasalazine, gold sodium thiomalate, and placebo in rheumatoid arthritis. Arthritis Rheum 1988 Jun; 31 (6): 702-13
38. Nishioka N, Nobunaga M, Sakuma A. Comparison of sulfasalazine and placebo in a randomized, double-blind controlled dose-finding study in patients with rheumatoid arthritis [in Japanese]. Ryumachi 1991 Jun; 31 (3): 327-45
39. Dougados M, Combe B, Cantagrel A, et al. Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components. Ann Rheum Dis 1999 Apr; 58: 220-5
40. Haagsma CJ, van Riel PLCM, de Jong AJL, et al. Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double-blind, 52 week clinical trial. Br J Rheumatol 1997 Oct; 36: 1082-8
41. Faarvang KL, Egsmose C, Kryger P, et al. Hydroxychloroquine and sulphasalazine alone and in combination in rheumatoid arthritis: a randomised double blind trial. Ann Rheum Dis 1993 Oct; 52 (10): 711-5
42. Nuver-Zwart IH, van Riel PL, van de Putte LB, et al. A double blind comparative study of sulphasalazine and hydroxychloroquine in rheumatoid arthritis: evidence of an earlier effect of sulphasalazine. Ann Rheum Dis 1989 May; 48 (5): 389-95
43. Neumann VC, Grindulis KA, Hubball S, et al. Comparison between penicillamine and sulphasalazine in rheumatoid arthritis: Leeds-Birmingham trial. Br Med J (Clin Res Ed) 1983 Oct 15; 287 (6399): 1099-102
44. Carroll GJ, Will RK, Breidahl PD, et al. Sulphasalazine versus penicillamine in the treatment of rheumatoid arthritis. Rheumatol Int 1989; 8 (6): 251-5
45. van der Heijde DM, van Riel PL, Nuver-Zwart IH, et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989 May 13; 1 (8646): 1036-8
46. Smolen JS, Kalden JR, Scott DL, et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. Lancet 1999 Jan 23; 353: 259-66
47. Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 1997 Aug 2; 350: 309-18
48. Mottonen T, Hannonen P, Leirisalo-Repo M, et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. Lancet 1999 May 8; 353: 1568-73
49. Goekoop-Ruiterman YPM, De Vries-Bouwstra JK, Van Zeben D, et al. Treatment strategies in early rheumatoid arthritis: clinical and radiological outcomes after 2 year follow-up of the Best study [abstract no. L4]. Arthritis Rheum 2004 Dec; 50 (12): 4096
50. Nishiya K, Hisakawa N, Tahara K, et al. Additive triple DMARD combination therapy of a low dose of sulfhydryl compounds, sulfasalazine and methotrexate in the treatment of rheumatoid arthritis: a clinical trial. Acta Med Okayama 1999 Dec; 53 (6): 275-9
51. Ferraccioli GF, Gremese E, Tomietto P, et al. Analysis of improvements, full responses, remission and toxicity in rheumatoid patients treated with step-up combination therapy (methotrexate, cyclosporin A, sulphasalazine) or monotherapy for three years. Rheumatology (Oxford) 2002 Aug; 41: 892-8
52. O'Dell JR, Haire CE, Erikson N, et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. N Engl J Med 1996 May 16; 334: 1287-91
53. Nagaoka S, Ohno M, Sekiguchi A. Effects of sulfasalazine added to methotrexate therapy on RA patients in refractory and escaped cases. Clin Rheumatol 2003; 15: 220-6
54. Singh A, Appel AM, Kvien TK. Results of patient-reported outcomes from a double-blind study of etanercept and sulphasalazine, alone and combined, in patients with active rheumatoid arthritis [abstract no. SAT0245]. Ann Rheum Dis 2003 Jul; 62 Suppl. 1: 355-6.
55. Plus poster presented at European League Against Rheumatism Annual Congress of Rheumatology; 2003 Jun 18-21; Lisbon
56. Haagsma CJ, van Riel PLCM, van de Putte LB. Combining sulphasalazine and methotrexate in rheumatoid arthritis: early clinical impressions. Br J Rheumatol 1995 Nov; 34 Suppl. 2: 104-8
57. O'Dell JR, Leff R, Paulsen G, et al. Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: results of a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2002 May; 46: 1164-70
58. Hamada Y, Shinomiya F, Okada M, et al. Usefulness of three-drug additional combination therapy with bucillamine, sulfasalazine and methotrexate for refractory rheumatoid arthritis. Int J Immunother 2002; 18 (2): 57-64
59. Capell HA, Madhok R, Hunter JA, et al. Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis 2004 Jul; 63 (7): 797-803
60. Ciconelli RM, Ferraz MB, Visioni RA, et al. A randomized double-blind controlled trial of sulphasalazine combined with pulses of methylprednisolone or placebo in the treatment of rheumatoid arthritis. Br J Rheumatol 1996 Feb; 35: 150-4
61. Svensson B, Ahlmen M, Forslind K, et al. Treatment of early RA in clinical practice: a comparative study of two different DMARD/corticosteroid options. Clin Exp Rheumatol 2003; 21: 327-32
62. Ritchie DM, Boyle JA, McInnes JM, et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968 Jul; 37 (147): 393-406
63. Salaffi F, Peroni M, Ferraccioli GF. Discriminating ability of composite indices for measuring disease activity in rheumatoid arthritis: a comparison of the chronic arthritis systemic index, disease activity score and Thompson's articular index. Rheumatology (Oxford) 2000; 39: 90-6
64. Felson DT, Anderson JJ, Meenan RF. Use of short-term efficacy/toxicity tradeoffs to select second-line drugs in rheumatoid arthritis: a metaanalysis of published clinical trials. Arthritis Rheum 1992 Oct; 35 (10): 1117-25
65. Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis: results of two metaanalyses. Arthritis Rheum 1990 Oct; 33 (10): 1449-61
66. Jones G, Halbert J, Crotty M, et al. The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials. Rheumatology (Oxford) 2003 Jan; 42 (1): 6-13
67. Weinblatt ME, Reda D, Henderson W, et al. Sulfasalazine treatment for rheumatoid arthritis: a metaanalysis of 15 randomized trials. J Rheumatol 1999 Oct; 26: 2123-30
68. Kalden JR, Scott DL, Smolen JS, et al. Improved functional ability in patients with rheumatoid arthritis: longterm treatment with leflunomide versus sulfasalazine. J Rheumatol 2001 Sep; 28: 1983-91
69. Scott DL, Smolen JS, Kalden JR, et al. Treatment of active rheumatoid arthritis with leflunomide: two year follow up of a double blind, placebo controlled trial versus sulfasalazine. Ann Rheum Dis 2001 Oct; 60: 913-23
70. Larsen A, Kvien TK, Schattenkirchner M, et al. Slowing of disease progression in rheumatoid arthritis patients during long-term treatment with leflunomide or sulfasalazine. Scand J Rheumatol 2001; 30 (3): 135-42
71. Porter D, Madhok R, Hunter JA, et al. Prospective trial comparing the use of sulphasalazine and auranofin as second line drugs in patients with rheumatoid arthritis. Ann Rheum Dis 1992 Apr; 51 (4): 461-4
72. Maetzel A, Wong A, Strand V, et al. Meta-analysis of treatment termination rates among rheumatoid arthritis patients receiving disease-modifying antirheumatic drugs. Rheumatology (Oxford) 2000 Sep; 39: 975-81
73. Galindo-Rodriguez G, Avina-Zubieta JA, Russell AS, et al. Disappointing longterm results with disease modifying antirheumatic drugs: a practice based study. J Rheumatol 1999 Nov; 26: 2337-43
74. McEntegart A, Porter D, Capell HA, et al. Sulfasalazine has a better efficacy/toxicity profile than auranofin: evidence from a 5 year prospective, randomized trial. J Rheumatol 1996 Nov; 23: 1887-90
75. Choy EHS, Scott DL, Kingsley GH, et al. Treating rheumatoid arthritis early with disease modifying drugs reduces joint damage: a randomised double blind trial of sulphasalazine vs diclofenac sodium. Clin Exp Rheumatol 2002; 20: 351-8
76. van der Heijde DM, van Riel PL, Nuver-Zwart IH, et al. Sulphasalazine versus hydroxychloroquine in rheumatoid arthritis: 3-year follow-up [letter]. Lancet 1990 Mar 3; 335 (8688): 539
77. Maillefert JF, Combe B, Goupille P, et al. Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five year follow up of a prospective double blind controlled study. Ann Rheum Dis 2003 Aug; 62 (8): 764-6
78. Landewe RBM, Boers M, Verhoeven AC, et al. COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum 2002 Feb; 46: 347-56
79. Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum 1981; 24 (10): 1308-15
80. Mottonen T, Hannonen P, Korpela M, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 2002 Apr; 46 (4): 894-8
81. Neva MH, Kauppi MJ, Kautiainen H, et al. Combination drug therapy retards the development of rheumatoid atlantoaxial subluxations. Arthritis Rheum 2000 Nov; 43: 2397-401
82. Korpela M, Laasonen L, Hannonen P, et al. Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease-modifying antirheumatic drugs: five-year experience from the FIN-RACo study. Arthritis Rheum 2004 Jul; 50 (7): 2072-81
83. Puolakka K, Kautiainen H, Mottonen T, et al. Impact of initial aggressive drug treatment with a combination of disease-modifying antirheumatic drugs on the development of work disability in early rheumatoid arthritis: a five-year randomized followup trial. Arthritis Rheum 2004 Jan; 50 (1): 55-62
84. Calguneri M, Pay S, Caliskaner Z, et al. Combination therapy versus monotherapy for the treatment of patients with rheumatoid arthritis. Clin Exp Rheumatol 1999; 17: 699-704
85. Amos RS, Pullar T, Bax DE, et al. Sulphasalazine for rheumatoid arthritis: toxicity in 774 patients monitored for one to 11 years. Br Med J (Clin Res Ed) 1986 Aug 16; 293 (6544): 420-3
86. Abramson J, James DS, McManus JP, et al. Amelioration of sulfasalazine-associated gastric intolerance by use of enteric-coated tablets. Pract Gastroenterol 1988; 12 (2): 32-9
87. Marmor D. The effects of sulphasalazine on male fertility. Reprod Toxicol 1995; 9: 219-23
88. Donovan S, Hawley S, MacCarthy J, et al. Tolerability of enteric-coated sulphasalazine in rheumatoid arthritis: results of a co-operating clinics study. Br J Rheumatol 1990 Jun; 29 (3):201-4
89. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med 2000 Mar 13; 160 (5): 610-9
90. British Society for Rheumatology. BSR guideline on standards of care for persons with rheumatoid arthritis [online]. Available from URL: http://www.msecportal.org/portal/editorial/PublicPages/bsr/536883013/ FinalRAStandards.pdf [Accessed 2005 May 4]
91. British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary [online]. Available from URL: http://www.bnf.org [Accessed 2005 Mar 17]
92. Kawai S. Current drug therapy for rheumatoid arthritis. J Orthop Sci 2003; 8 (2): 259-63
93. Santen. Azulfidine® (salazosulfapyridine) EN tablets: prescribing information. Japan: Santen, 2005
94. van Jaarsveld CHM, Jacobs JWG, van der Veen MJ, et al. Aggressive treatment in early rheumatoid arthritis: a randomised controlled trial. Ann Rheum Dis 2000 Jun; 59: 468-77
95. British Society for Rheumatology. National guidelines for the monitoring of second line drugs [online]. Available from URL: http://www.rheumatology.org. uk [Accessed 2005 May 5]
96. Jarvis B, Faulds D. Etanercept: a review of its use in rheumatoid arthritis. Drugs 1999 Jun; 57 (6): 945-66
97. Kremer JM. Rational use of new and existing disease-modifying agents in rheumatoid arthritis. Ann Intern Med 2001 Apr 17; 134 (8): 695-706
98. Jobanputra P, Wilson J, Douglas K, et al. A survey of British rheumatologists' DMARD preferences for rheumatoid arthritis. Rheumatology (Oxford) 2004 Feb; 43 (2): 206-10
99. Garrood T, Scott DL. Combination therapy with disease modifying anti-rheumatic drugs in rheumatoid arthritis. Biodrugs 2001; 15 (8): 543-61
100. Goekoop YP, Allaart CF, Breedveld FC, et al. Combination therapy in rheumatoid arthritis. Curr Opin Rheumatol 2001 May; 13 (3): 177-83
101. Choy EH. Two is better than one? Combination therapy in rheumatoid arthritis. Rheumatology (Oxford) 2004 Oct; 43 (10): 1205-7