Triple Therapy for Rheumatoid Arthritis: Pros and Cons

There are many treatment options for rheumatoid arthritis. One of the most widely used is triple therapy. We'll explain it to you.
Triple Therapy for Rheumatoid Arthritis: Pros and Cons

Last update: 27 May, 2022

Rheumatoid arthritis is an autoimmune inflammatory disease characterized by chronic pain in several joints, mostly in the wrists and fingers. Delay in diagnosis and failure to address it is associated with long-term disability and disability. Here are the advantages and disadvantages of triple therapy for rheumatoid arthritis.

It currently affects between 0.4 and 1% of the population, with up to 6 times more common in women, according to studies. In general, treatments for this disease are aimed at relieving pain and joint stiffness, as well as preventing the progression of damage.

The most commonly used therapy is with disease-modifying antirheumatic drugs. The use of a single drug for the management of this condition is common. However, if this doesn’t improve symptomatology, combination, or triple therapy may be necessary in the management of rheumatoid arthritis.

Medications used

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

In this regard, 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 alleviate symptomatology and delay progression.
  • Corticosteroids: Prednisone and dexamethasone. They reduce inflammation by slowing down the immune response.
  • Biological drugs: Abatacept, adalimumab, certolizumab, etanercept, infliximab, rituximab, sarilumab, tofacitinib, and tocilizumab. These are biologic proteins that inhibit the tissue inflammation cascade by disrupting signaling.

Generally, these drugs can be prescribed in monotherapy or in combination therapies, depending on the characteristics of rheumatoid arthritis. Physicians are the only ones qualified for this task.

You may be interested in reading: 3 Turmeric Remedies for Rheumatoid Arthritis

What is triple therapy?

Triple therapy is a medical treatment in which three oral drugs are prescribed in parallel for the relief of RA symptoms. This therapy is usually prescribed when there’s no response to the one or two-drug approach.

In most people, methotrexate, sulfasalazine, and hydroxychloroquine are combined. Other options combine methotrexate with biologic drugs.

Pain in the hand.
Chronic pain is difficult to cope with. Patients become discouraged with the passage of time and persistence of symptoms.

Advantages and disadvantages of triple therapy in rheumatoid arthritis

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

Similarly, people with rheumatoid arthritis who receive triple therapy improve in a shorter time, in a sustained manner, and with less risk of symptom intensification. In addition, 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 cost advantages. In this regard, triple therapy for rheumatoid arthritis is a more cost-effective strategy compared to the use of new-generation biologic drugs, according to studies.

Similarly, rapid relief is associated with lower work absenteeism.

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

Some research states that sulfasalazine often causes headaches, dizziness, nausea, and vomiting. Methotrexate, on the other hand, shows liver, lung, and hematologic toxicity.

A pain in the kidney.
The adverse effect of liver toxicity should be monitored with regular tests in these patients.

A strategy with great benefits in rheumatoid arthritis

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

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

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Massardo Loreto. Artritis reumatoide temprana. Rev. méd. Chile. 2008;  136( 11 ): 1468-1475.
  • Secco A, Alfie V, Espinola N, Bardach A. Epidemiología, uso de recursos y costos de la artritis reumatoidea en Argentina. Revista Peruana de Medicina Experimental y Salud Pública. 2020;37(3):532-40.
  • Abásolo Alcázar L. Triple terapia en la artritis reumatoide. Reumatología Clínica. 2014;10(5):275-277.
  • Moreland LW, O’Dell JR, Paulus HE, Curtis JR, et al. A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: the treatment of Early Aggressive Rheumatoid Arthritis Trial. Arthritis Rheum. 2012 Sep;64(9):2824-35.
  • De Jong PH, Quax RA, Huisman M, Gerards, et al. Response to glucocorticoids at 2 weeks predicts the effectiveness of DMARD induction therapy at 3 months: post hoc analyses from the tREACH study. Ann Rheum Dis. 2013 Oct;72(10):1659-63.
  • Mulero Mendoza J. Tratamiento de la artritis reumatoide. Revista Clínica Española. 2004; 204(5): 273-282.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.