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Starting combination therapy - sulfasalazine or hydroxychloroquine???

Hi all,

Its been a while since I've been on but wondered if anyone has any info on which one to add to methotrexate???

Diagnosed sero-neg RA in April this year after 3 months of multiple joint pain, stiiffness & sweeling since Jan. Been on Metho for 12 weeks with only marginal improvement. Currently also reducing prednisolone (very slowly due to withdrawal side effects - not pleasant!!!) Was on 20mg dose for 16 weeks now down to 9mg. Back in pain, swelling and stiiffness again, fatigue unbelievable (sleeping 10hrs plus some days)

Seeing Rheumy Nurse tomorrow about starting combination therapy - Metho plus either sulfa or hydrox???

Bit concerned about hydrox as already developed probs with eye sight from pred and metho???

But wondering if Metho and Sulfa will do the job???

I was given the impression that the Metho would work after 12 weeks but not the case πŸ˜• Any info on best combination would be much appreciated πŸ‘

Many thanks,

Julied x x

4 Replies
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Unfortunately there's no guaranteed best combination as it's so individual. The specific eyesight problems that hydroxy can cause are very rare, but if you are having problems anyway you should get this checked out.

I take all three, so hard to tell whether one does more than another. If I drop doses of any of them I flare.... MTX can take up to 6 months to work and the other take ages too. All in all it was about a year before I started to get this under control.

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Thanks Helix,

Much appreciated.

Yes, just did some more research and understand UK tend to do a step-up method with DEMARDS (altho I notice NICE recommend combination therapy of at least 2 DM's right from the start!)

Whislt other research seems to favour a tri-therapy of all 3 like yourself, (and then decrease if possible once inflammation under control). But as you say it's all very different for each of us!

I also think being told the metho would have it all settled within 12 weeks didn't help! Need to be more realistic I think of how long this may take - especially as I didn't start on any treatment until 3 months after the RA kicked off.

Thanks for info about hydroxy too.

Many thanks again,


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OH. Had the same as you. I asked why they didn't start with combination therapy as suggested by guidelines, and they said because if they start someone on 3 at once and they can't tolerate it, how do you know which one isn't tolerated? I thought that was a fair reason.

OH started MTX, then after about 5 months hydroxy was added in, the after another 12 weeks sulfasalazine. That was 6 weeks ago, and I'm afraid to say we still haven't cracked it.

The joint pain and stiffness, and fatigue are both less bad than they were untreated, but he still feels generally really ill a lot of the time and lacking in energy.

Sorry to come across as negative, I do think both we and you will get there with treatment in the end, but I think you have to be prepared for the fact that it could be a long process of trial and error to find the combination of drugs that works best for you.

Good luck.


Thanks Chickenkeeper,

Saw Rheumy Nurse, who was excellent and really took the time to find out how I was doing. She explained that it can take time to get the right combination of meds and exactly what you said abiut them adding them one at a time so they know which med is doing what re: reducing inflam, stiffness & pain vs. side effects!

Started on sulfasalazine last Saturday - just one tablet a day this week and so far absolutely wiped out - slept over 12 hours yeserday and just having to crawl to bed at times! I'm hoping this will settle once my body gets used to sulfa!

So I'm trying to be a lot more realistic and patient!!! (Easier sad than done!!!) and as positive as poss, in the belief it will settle down at some point!!!

Hope yours responds too and things improve sooner than later for us both!

Very best wishes,



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