"Triple therapy works just as well as methotrexate plus a biologic for patients with active rheumatoid arthritis (RA), according to a new study published online in The New England Journal of Medicine. The results of this study may help guide treatment for patients who don’t improve enough on methotrexate alone."
It's not a long article nor too complex but may be quite useful.
Thanks for that. Makes for a good read.
Thanks, an interesting article. And it's certainly my experience that triple therapy has worked well for me, as that's what I'm on now. It seems also to reinforce the fact that different drugs suit different people better, so I just wish there was a way of knowing whether you're the person who does well on triple therapy, or on MTX+biologic. Polly
That's a really interesting article.
I am on Triple Therapy and for now I seem to be managing this disease reasonably well.
It's a pity there was no detail about the doses they used.
I have wondered if Biologics would be better for me...perhaps not after all. And which ones are the best? There seem to be more and more in development all the time.
Just read it also, interesting as I was started on triple therapy (full dose of each) and was on this for 7 months, it did not make any difference whatsoever for me 
on the up side I was then put on a biologic and my DAS dropped from around 6.4 to 1.35 within 8 weeks and has remained that way for 20 months 
For me, triple therapy was the way to go as I was then able to start my biologic without any delay (having to fail 2 or 3 dmard's before consideration)
as Polly says different drugs, different people.
I would love to know which is better long term for our bodies though. The side effect were far worse for me on triple therapy.
thanks fruitycake!
Oh wow!! Like u I've been on triple therapy with very high das scores, have just started cimza . Really hoping I have a response like yours. You've given me hope. Hope it continues for you.
Did u have to give up work? If so, have u been in a position to return to work may I ask. I'm interested because I returned to work , after 6 months I've had to hand my notice in.
I'm still working, I was on maternity leave (baby was 6 weeks old when RA hit) so this allowed me some extra time. Before I started Enbrel I really didn't think I could cope with bringing up family let alone work.
My work sent me to an Occupational health Doctor who confirmed that I was starting a new treatment and would benefit from additional time off to give the meds time to work, then I had a phased return. I work 3 days a week but lucky to work at a college so now have school holidays
Great your starting cimza, of course there hope, these treatments can be nothing short of a miracle! I am 90% better and my Consultant confirmed there is no sign of disease progression.
I'm sure you've taken advice about handing your notice in but is there no other alternative? do you have a HR dept where you work?
Thank you, unfortunately I didn't . Just left as I'd only been there for 6 months, truth be told I'm seeing this as an opportunity to change direction. Perhaps undertake further study and progress in a new , less physical and hopefully more rewarding job. Well that's the plan!!
Hope u continue to have low Das scores and be able to do what u enjoy. ????
Brilliant news, pleased your DAS has stayed low for so long. ??
I'm one of the very lucky ones Julie! really, I feel so blessed but never take it for granted!
Pleased for you x long may it continue xx
I had no response to hydroxy alone, minimal response to 20mg oral MTX, better response to 20mg injected MTX followed a bad reaction when we added sulfa. We added leflunomide (10mg), then I had a fairly good 6 months on both MTX and leflunomide. However, in recent weeks, I have slipped back and I am as ill as I was at diagnosis. I'm being assessed for cimzia but I wonder if I should try to add another DMARD to Lef and MTX....? I'm quite nervous about trying anti-TNFs.
I think you should probably hope that you can try anti-tnfs Fruity. I have tried Sulpha and only lasted 3 weeks because of severe side effects, then MTX orally and then Hydroxy was added because of liver side effects but increase in disease activity. Nothing changed for me properly until I switched to injectable MTX - which really helped a lot. But unfortunately side effects have meant I've just had to drop a few doses and for some reason my GP and rheumy don't want Hydroxy re-introduced because they feel it made no significant difference to my RA. I'm being assessed for anti-tnfs soon too. So I've only tried the combination of Hydroxy and MTX and only for about a year.
I don't think I'll qualify for biologics bu alsot not sure that 12.5mg injectable MTX is going to be enough to get me into remission ever. It's such a juggle but I don't think I'd rather try Leflunomide than anti-tnf because I suffer from raised blood pressure and dread the side effects that I've read about with Leflunomide too. I suspect it will have to be added before I can try anti-tnfs though because my DAS won't be high enough. Tilda x
Thanks an interesting article, I seem to be one off the awkward ones so far I've tried triple therapy, then 5 biologics and none have worked there magic yet, I'm about to start my 6th and like Poly I just wish there was a way off knowing what drug suits you.
hi changing the subject a bit, out of interest which biologiics have you tried ? and why did they fail? i have just tried my second one and i feel its not the one for me !! after taking humria i have spent the last five days in bed and never wanna go through that again. also tried enbrel.
It's such a fine balance. The rheumy who diagnosed me said it's best to be on the lowest possible doses to control the disease and I'd be lying if I said anti-TNFs don't concern me. However my seronegative RA that rarely leaves me with a elevated CRP is causing erosions and I've become quite disabled, so I need to take that leap of faith I suppose..? It's been a long 4 years.
Glad to read this as that's what has worked for me so far, methotrexate sulphasalazine and hydroxychloroquin , worked so well now halved my tramadol and naproxen.
Was on triple therapy for about 18 months but gradually my disease became more active, My rheumy was keen to get me on to biologics as she felt I was an ideal candidate for them. and was taken off it and put on Cimzia and a reduced level of MTX (10mg). It has worked well for me though recently had Hydroxychloroquine added back. Went for my review meeting yesterday and the nurse was happy with my joints. My disease is in remission at the moment.
Most DMARDS work by dampening down the immune system so tend to increase the risk of infection to some degree biologics add a theoretical extra risk in this respect.
Methotrexate side effects
Side effects from methotrexate 
Side effects from biologics
Update to consultant appointment & triple therapy
Biologics and methotrexate
