Combination sulfasalazine and methotrexate in the management of rheumatoid arthritis

I wished to review the pharmacology and current clinical experience with the combination of methotrexate and sulfasalazine as a management for rheumatoid arthritis. To date, no double blind randomized placebo controlled studies have been reported, though such studies are under way. Published experience is in excess of 100 patients and for as long as 8 years of followup. To date, the combination would appear to be well tolerated, with comparable toxicities to the individual agents taken as monotherapy. Withdrawal flare reports support a positive clinical effect of this combination. The results of ongoing controlled trials are awaited with interest.