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Many patients with rheumatoid arthritis (RA) respond to methotrexate, but a considerable number have inadequate response. Four approved tumor necrosis factor (TNF) antagonists are considered to have mutually comparable effects in RA. Methotrexate and TNF antagonists have been demonstrated to decrease joint inflammation and prevent deformity and appear to prevent the cardiovascular complications prevalent in patients with chronic inflammatory conditions.
Investigators randomly assigned methotrexate recipients with inadequate response to add sulfasalazine plus hydroxychloroquine or etanercept to their RA therapy. Both groups noted improvement over the course of the study, but patients with continued inadequate response at 24 weeks (27% of pati…