Hi Seenie, Just caught up with this thread.
Triple therapy, or combination therapy, is common these days. Most research into inflammatory or auto-immune arthritis begins with RA because it is the most commonly seen type of inflammatory arthritis. Rheumies used to treat arthritis by beginning with nsaids, then moving to more aggressive drugs when nsaids failed (typically nsaids, then MTX, then biologics). In this way, they saved the biggest guns for later in treatment when symptoms and complications were more severe. The logic was that since stronger drugs seemed to carry a risk of serious side FX, it was better to put off treatment with dmards until later stages of treatment.
Now, the focus has changed. RA is believed to respond better to early aggressive treatment, meaning, by using the bigger guns first, the potential for developing serious complications of RA is reduced and overall outcomes are improved (fewer erosions, deformities, etc).
Fast-forward in RA research: Benefits are even greater with triple (or even double) therapy than with single therapy. It's an aggressive way of treating arthritis, but surprisingly doesn't seem to increase the risks of side FX over a single therapy regimine. The same logic is being applied to other types of arthritis, including PsA, but little research has been completed on combination therapies and PsA. In RA, some combinations appear to yield better results than others. MTX, sulphasalazine, and plaquenil is a very beneficial combo seen in RA research.
I've been on double therapy (MTX and plaquenil) since late summer with good results in terms of pain relief, IMHO. But my rheumy is delighted as inflammation and swelling seem to be down. My toes that were beginning to curl and deform are back in line and I do have less pain in my lower back, toes, SI joints and a few other joints. This is all very good news, but my expectations were way too high--I wanted total remission, which probably is unrealistic. Still, although my rheumatolgist is pushing for me to discontinue the plaquenil in spring, I am reluctant to alter a plan that seems to be working! I also take Asacol for inflammatory bowel disease, which is a variant of sulphasalazine, so I may be getting some benefit from that, as well.
You can read more about combination therapies here: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides...
Many insurance companies do require at least a trial with MTX before they will consider paying for a biologic. For example, with Medicare, rheumy said, they like for you to do at least a 3 month trial of MTX with failure before they will pay for a biologic. It's interesting that a lower percentage of people on Medicare Part D are using biologics than is true for the general population. I have checked into the cost of simponi to me, and I believe the discrepancy is most likely because of cost to the patient. For example, if I were taking simponi alone (no other drugs at all for any health condition), the cost of simponi to me would be in the neighborhood of $4150/year, with prior approval. That's simply beyond realistic for me, and for many retirees who have only Medicare Part D to rely on for drug coverage.
Hope this helps!