Combination Therapy
				It is being suggested by several  centers that combination  therapy is the best form of therapy with better   response rates  compared to individual therapy. Combinations have been used in  different  formats, including "step-down models", starting with several drugs  and  then dropping agents consecutively, eventually maintaining  a mild DMARD  long-term 35. "Saw-tooth" models are also  proposed. These entail   early use of DMARD, with replacement of  each in turn by another as the efficacy  of the respective drug   subsides 36. The standard practice with RA  management  however, remains initial treatment with single drug therapy. If  patients do not show an adequate response, then the drug may either  be  substituted or a second DMARD drug added. A number of combinations  have been  shown to be potentially superior to monotherapy with  respect to both efficacy  and toxicity. These should de done under  Rheumatologist supervision, especially  in cases of resistance  to monotherapy. Regimen's include: Methotrexate - Chloroquine Methotrexate - Sulphasalazine Methotrexate - Cyclosporine Sulphasalazine -  Hydroxychloroquine O'Dell recommends  continuation of  triple therapy with methotrexate, sulphasalazine  and hydroxychloroquine, thereby  increasing remissions and reducing  / preventing recurrence of disease. Initiation of  combination therapy as the initial therapy may be  indicated in  severe disease but long term data is still  required.