The management of rheumatoid arthritis (RA) in the past three decades has undergone a paradigm shift from symptomatic relief to a "treat-to-target" approach. This has been possible through use of various conventional and biologic disease modifying anti-rheumatic drugs (DMARDs) which target disease pathogenesis at a molecular level. Cost and infection risk preclude regular use of biologics in resource-constrained settings. In the recent years, evidence has emerged that combination therapy with conventional DMARDs is not inferior to biologics in the management of RA and is a feasible cost-effective option.
Keywords: Biologics; Cyclosporine; Disease modifying drugs; Hydroxychloroquine; Leflunomide; Methotrexate; Radiologic outcome; Remission; Rheumatoid arthritis; Sulfasalazine; Tumor necrosis factor.