Whereas the optimum therapy for early rheumatoid arthritis (RA) has not been established, there is still interest in combination therapy with existing disease-modifying antirheumatic drugs, due to the cost and toxicity of biological agents. We previously reported a 24-month open-label, randomised study comparing a methotrexate and ciclosporin A combination with sulfasalazine monotherapy in 82 early, poor-prognosis RA patients (n  =  40 combination, n  =  42 sulfasalazine).1 In the combination arm, first ciclosporin A then methotrexate doses were optimised. After 24 months all patients were treated according to standard clinical care. The aim of this report is to present long-term efficacy and toxicity data.

At 12 months there was no difference in …