149 Papers Treatment of Rheumatoid Arthritis in Combined Therapy with Methotrexate Treatment of Rheumatoid Arthritis in Combined Therapy with Methotrexate Sylejman Rexhepi, Gani Dragusha, Mjellma Rexhepi, Ejup Pllana, Vjollca Sahatçiu-Meka, Masar Gashi, Hajrije Hundozi- Hysenaj, Sadik Llullaku Clinic of Internal Disease, Rheumatologic Department, University Clinical Centre Kosova, Prishtina, Kosovo Clinic of Internal Disease, Physiatry Clinic, Clinic for Surgery, University Clinical Centre, Prishtina, Kosovo ORIGINAL PAPER SUMMARY In 2 years study, at Rheumatologic Department of University Clinic Centre in Pristina, it was done application of combined therapy with Methotrexa- te (tablets Methotrexate of 15 mg weekly, Sulphasalazine 2g daily, Hydroxychloroquine 400 mg) to patients with rheumatoid arthritis. Methods: During our investigation were treated 20 patients, 18 females and 2 males, in the treated group with Methotrexate, and 20 patients 16 female and 4 male in treated group with Methotrexate (MTX), Sulphasalazine (SSZ) and Hydroxychloroquine (HCQ). The diagnosis of rheumatoid arthritis was concluded on diagnostic criteria of American Rheumatism Association (ARA). The aim of this study is to compare medical results between group I (with tablets Methotrexate), as simple therapy and group II (with MTX, SSZ and HCQ), as combined therapy of drugs that modify rheumatic diseases (DMARDs), according to laboratory analysis, subjective and objective parameters, as well as side efects of drugs that were used. During application of DMARDs we were based on principals of drug applications. Results: To the investigated patients of group I and II that were of ages (23–72 years old vs. 21-69 years old) with average (46 vs. 45). Most of the patients of group 1 and 2 belong in 1st and 2nd functional stage according to Steinbrocker. Average value of morning stifness for group 1 and 2 was (69.5 vs. 73 minutes) in the beginning of treatment, while in the end of the treatment was (26 vs. 21minutes, p<0.01). Average value of hands grip before the medication was (67 vs. 62 mm), while after medication (85 vs. 92 mm, p<0.01). Pain to all patients of group I and II before the medication was present, but after the medication changed intensively, had no pain (5 vs. 9 patients), had light pain ( 13 vs. 10 patients), while remained patients with strong pain ( 2 vs. 1 patients). Average value of swelling on proximal interphalangeal joints in group I and II in the beginning of medication was (70 vs. 67 mm), while after the medication was (68 vs. 62 mm). Average value of erythrocytes sedimentation before the medication was (33 vs. 38) while after the medication was (19 vs. 14). The positive rheumatoid factor was found to (15 vs. 17 patients). After the medication is achieved the reduction of titer (2 vs. 4 patients), while to others, the titer value remained unchanged. After the medication with DMARDs from side efects leucopenia was founded to (2 vs. 3 patients), while in two groups, only one patient had protein in urine, thrombocytopenia and pruritus, in group I and II in two patients were manifested gastrointestinal complications: with nausea, vomiting and gastric pain, in group II diarrhea, rush and alopecia. Conclusions: According to our results we concluded efcacy of the combination of DMARDs (MTX, SSZ, HCQ) as combined therapy compared with medication of simple therapy (MTX) to the patients with rheumatoid arthritis. The combined therapy of DMARDs caused visible clinic improvement, have decreased laboratory parameters, disease activity and have improved life quality. Key words: rheumatoid arthritis; DMARDs 1. INTRODUCTION Drugs that modify the rheumatic diseases (DMARD-a) in the treatment of early stage of rheumatoid arthritis we achieved slowing the progression of the disease, preventing disability and optimal normalization of the functions of the locomotor system (1,2,3). Within the DMARD system are gold salts, synthetic antimalarics (hydroxychloroquine- HCQ), sulphasalazine (SSZ), methotrexate (MTHX), and manifest indicated efects from 4 weeks to 12 months. Te treatment begins at an early stage and the individualization of dosage depends on patient tolerance and therapeutic re- sponse. Methotrexate in combination with sulphasalazine hydroxychloroquine and compared with methotrexate as the only therapy showed to be much more efective. Methotrexate (MTHX) amethropine, folic acid antago- nist, is administered in patients with rheumatoid arthritis since 1983 (3,4,5). Hydroxychloroquine, sulphasalazine as an independent therapy was applied several years earlier. A few years later is introduced the application of methotrex- ate in the Rheumatology department at Pristina (6,7,8,9). In recent years applied is the triple-DMARD therapy. DMARD mechanism of action is unknown. Some authors have ex- plained the result of action: through elimination of immu- nocompetent cells (10,11). So that immunosuppression as a result of action of cytostatic, is explained by the inhibition of cellular and humoral, immune responses. In the course of applying DMARD authors noted reduc- tion in titer of rheumatoid factor in serum. Antifogistic action was explained by the product inhibition of infam- matory mediators (11). Efects Side efects are numerous