Triple therapy for rheumatoid arthritis: advantages and disadvantages


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There are multiple treatment options for rheumatoid arthritis. One of the most used is triple oral therapy. We explain it to you.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by chronic pain in various joints, especially the wrists and fingers. The delay in diagnosis and the failure of the approach are associated with disability and long-term disability. Here are the advantages and disadvantages of triple therapy for rheumatoid arthritis.

Currently, it affects between 0.4 and 1% of the population, being up to 6 times more common in women, according to studies. In general, treatments for this disease seek to relieve pain and joint stiffness, as well as prevent the progression of damage.

The most widely used therapy is with disease-modifying antirheumatic drugs. The use of a single medication for the management of this condition is common. However, if this does not improve symptoms, combined or triple therapy may be necessary to control rheumatoid arthritis.

Medications used

Today, there is a vast number of drugs that can be used in the management of RA. Research affirms that methotrexate is one of the first-line drugs.

In this sense, we can find the following groups:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen and naproxen. They reduce swelling and joint pain.
  • Disease-modifying antirheumatic drugs (DMARDs): methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. They relieve the symptoms and delay the evolution.
  • Corticosteroids: prednisone and dexamethasone. They decrease inflammation by slowing down the immune response.
  • Biologic drugs: Abatacept, adalimumab, certolizumab, etanercept, infliximab, rituximab, sarilumab, tofacitinib, and tocilizumab. They are biological proteins that inhibit the inflammation cascade of the tissues by interrupting the signals.

In general, these drugs can be indicated as monotherapy or in combination therapies, depending on the characteristics of rheumatoid arthritis. Doctors are the only ones trained for this task.

What is triple therapy?

Triple therapy is a medical treatment in which 3 oral drugs are indicated in parallel for the relief of RA symptoms. In general, this therapeutic scheme is prescribed when there is no response to the approach with one or two drugs.

In most people, methotrexate, sulfasalazine, and hydroxychloroquine are combined. Other schemes combine methotrexate with biological drugs.

Rheumatoid arthritis pain.
Chronic pain is difficult to cope with. Patients become discouraged with the passage of time and the persistence of symptoms.

Advantages and disadvantages of triple therapy in rheumatoid arthritis

Each of the drugs used in the management of rheumatoid arthritis provides great benefits. The main advantage associated with triple therapy is greater effectiveness in relief. Studies claim that this combined plan has greater potency and better results.

Similarly, people with rheumatoid arthritis who receive triple therapy are able to achieve clinical improvement in less time, in a sustained manner, and with less risk of worsening symptoms. Furthermore, research has shown that the combination of methotrexate, sulfasalazine, and hydroxychloroquine is useful in the early aggressive attack of this condition.

This therapeutic option shows important advantages from the point of view of costs. In this sense, triple therapy for rheumatoid arthritis is a cheaper strategy compared to the use of new generation biological drugs, according to studies.

Similarly, quick relief is associated with less absenteeism from work.

Although the drugs used are relatively safe, the main disadvantage of triple therapy is the adverse events associated with its use. Hydroxychloroquine is associated with skin rash, abdominal pain, and diarrhea.

Some research claims that sulfasalazine often causes headache, dizziness, nausea, and vomiting. For its part, methotrexate shows toxicity at the hepatic, pulmonary and hematological levels.

Methotrexate has liver toxicity.
The adverse effect of liver toxicity should be monitored with regular laboratories in these patients.

A strategy with great benefits in rheumatoid arthritis

Rheumatoid arthritis is a chronic disease that has a wide variety of therapeutic options. The use of methotrexate and anti-inflammatory drugs at the beginning of the pathology is common. However, the combined therapy and the triple strategy show greater efficacy in the rapid relief of symptoms and in the arrest of joint damage.

Rheumatologists are the specialists in charge of the indication. Its use will depend on the age, constitution, general condition and severity of the condition.

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