INTRODUCTION

It is known that a ‘treatment window’ exists in early RA, during which optimal treatment provides a better long-term outcome. A delay in the administration of DMARD therapy reduces the likelihood of RA patients achieving disease remission, and is associated with more rapid radiological progression and worse functional outcomes. (Dale et al. 2007). Different strategies are available for the treatment of RA. Combination therapy can involve a step-up approach, a parallel approach or a step-down approach (Fig. 1). However, there is no consensus regarding either the most effective strategy, or the combination of DMARDs for the treatment of RA.