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[Comment] Beyond methotrexate monotherapy for early rheumatoid arthritis

Findings from the U-Act-Early strategy trial in patients with early rheumatoid arthritis by Johannes Bijlsma and colleagues1 in The Lancet suggest that current standard care initiating monotherapy with the conventional synthetic disease-modifying antirheumatic drug (DMARD) methotrexate is suboptimal. The trial investigators enrolled 317 patients from 21 Dutch rheumatology outpatient departments and randomly assigned them to start tocilizumab (an interleukin-6 receptor-blocking monoclonal antibody) plus methotrexate, or tocilizumab, or methotrexate.