Two arthritis drugs work best in tandem.

Two anti-inflammatory drugs for rheumatoid arthritis work better together than either does individually, researchers report in the Feb. 28 Lancet.

The scientists randomly assigned one-third of 682 arthritis sufferers to receive methotrexate pills, a frontline arthritis drug, plus twice-weekly injections of the drug etanercept. The other volunteers received either methotrexate plus an inert shot, or etanercept shots in combination with inert pills.

After one year, 522 of the patients had completed one of the three regimens. Arthritis went into remission in 35 percent of those getting combined treatment but only 16 percent of patients getting just etanercept and only 13 percent of those receiving just methotrexate, says study coauthor Lars Klareskog, a rheumatologist at the Karolinska Institute in Stockholm.

The researchers took X rays of the patients' hands, wrists, and feet at the start of the study and after 6 and 12 months of treatment. The images showed that patients getting the combination of drugs had less joint damage than the others did. Indeed, Klareskog says, the condition of some patients' joints even improved after a year of combination therapy, although the mechanism underlying the repair process is not known.

When initially diagnosed with severe rheumatoid arthritis, most patients receive methotrexate or a similar drug, Klareskog says. If that fails to help within 2 months, doctors should use the combination treatment, he says.--N.S.