Layered or Step Approach
Given the recent evidence and the important questions still outstanding, a layered, "step-up" or "step-down" approach probably describes the manner in which therapies are administered in the majority of cases today. One or more drugs may be given for a period of time; depending on symptoms one or more may be added or dropped as needed.
Because there are so many potential combinations, it is not possible to list a typical regimen. Numerous variables affects which drugs may be prescribed at a given time, including the severity of disease, how well a particular drug has worked for an individual, patient preferences regarding pills or injections, side effects, and other factors.
Overall, however, doctors are increasingly using stronger medications first, based on studies showing that joint damage can be slowed or stopped with the early use of such drugs. Combinations of DMARDs (especially methotrexate) and biological drugs (TNF modifiers) are considered by far the most effective therapies. DMARDs combined with a corticosteroid such as prednisone are also showing good results.
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