Induction Therapy with Combination TNF Inhibitor and Methotrexate in Early Rheumatoid Arthritis

Part of the following topical collections:
  1. Topical Collection on Rheumatoid Arthritis


With the introduction of more objective disease activity measures and the development of biological therapies, there were dramatic changes in the treatment of rheumatoid arthritis (RA). The combination therapy with tumor necrosis factor (TNF) inhibitor and methotrexate (MTX) has unprecedentedly improved prognosis and outcomes, and very low disease activity or remission has been achievable goal in RA. Although the concept of remission induction and maintenance was first discussed in longstanding RA patients, several clinical trials have demonstrated that there is a therapeutic window of opportunity, and early effective control of inflammation in early RA could lead to less joint damage and better long-term outcomes. Emerging evidence suggests that early combination therapy with TNF inhibitor and MTX leads to rapid clinical remission and thereby improved quality of life. Furthermore, remission status may be sustained in some patients even if a TNF inhibitor is discontinued after sustained remission in early RA patients. While there are many potential benefits of early remission induction therapy with the combination of a TNF inhibitor and MTX, the best therapeutic regimen and strategy for remission induction and maintenance in early RA remain controversial. There are no data to decide a priori when and in whom TNF blocker drugs are indicated in early disease-modifying anti-rheumatic drug (DMARD)-naïve RA.


Early rheumatoid arthritis Tumor necrosis factor inhibitor Induction therapy Remission Treatment Combination Methotrexate TNF inhibitor Remission induction Maintenance 


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Conflict of Interest

Yong Gil Hwang and Larry W. Moreland declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Rheumatology and Clinical ImmunologyUniversity of PittsburghPittsburghUSA

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