Introduction: Rheumatoid arthritis is the most common inflammatory disease of the joints with an incidence of about 4-13 in 100,000 males and 23-36 in 100,000 females. It is recommended that the drug treatment should start within short period of 6 weeks to arrest progression of disease, joint erosion and deformation. Aggressive treatment in the initial stage of the disease with DMARDS reduces the disease progression. The responses of patients with rheumatoid arthritis to treatment with a single so-called disease-modifying drug, such as methotrexate, are often suboptimal. Despite limited data, many patients are treated with combinations of these drugs. Objective: The aim of the study was to compare the efficacy of hydroxychloroquine, methotrexate and combination of hydroxychloroquine, methotrexate and sulfasalazine in induction of remission in early rheumatoid arthritis. Methodolgy: The present study included 50 randomly selected cases of rheumatoid arthritis, who presented at PES Hospital, during July 2014 to July 2016 fulfilling the inclusion and exclusion criteria. Following collection of data in a pretested proforma, which included brief history, physical examination and ACR criteria, the patients were divided randomly into two groups. The first group, Group A, was treated with once a week oral methotrexate 7.5 mg and twice daily oral Hydroxychloroquine. The second group, Group B, was treated with once a week oral methotrexate 7.5 mg and twice daily oral Hydroxychloroquine 200 mg and salfasalazine 500 mg twice daily. Patients in both the groups received additional oral folic acid 5 mg thrice daily once a week. Patients in both the study group received oral sustained release aceclofenac and paracetamol twice daily for the first 10 days. All the patients were followed up in the out-patient department of the hospital at 4 weeks interval for 12 weeks and evaluated by the ACR criteria for remission and improvement in symptoms. Blood investigations like haemoglobin level, RA factor, ESR, and liver enzyme levels were done before initiating treatment for all patients. All patients underwent haemoglobin level, ESR, and liver enzyme levels at every followup visit. Results: At the end of three months group A which was treated with two drug regimen had remission in 32% and group B patients treated with three drug regimen had 52% remission rate according ACR criteria for remission. Remission was more in seronegative arthritis than seropositive. Conclusion: Remission was induced in higher number of patients on combination therapy with methotrexate, hydroxychloroquine and sulfasalazine when compared to patients on treatment with methotrexate and hydroxychloroquine.

Keywords: RA factor; methotrexate; Rheumatoid arthritis; Hydroxychloroquine.