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. 2025 Aug 20;12:1618493. doi: 10.3389/fmed.2025.1618493

Figure 1.

Table showing treatment strategies. Strategy 1: Methotrexate alone. Strategy 2: Methotrexate to Triple therapy. Strategy 3: Methotrexate to b/tsDMARD1. Strategy 4: Methotrexate to Triple therapy to b/tsDMARD1. Strategy 5: Methotrexate to Triple therapy to b/tsDMARD2. Strategy 6: Methotrexate to b/tsDMARD2.

Treatment algorithm of the six included strategies. Each treatment strategy is initiated with methotrexate as the first-line drug. The arrows depict the next drug option if patients did not achieve treatment target. In all arms patients are placed on rescue therapy (methotrexate+daily prednisolone <10 mg) if treatment goal was not reached. Triple therapy indicates combination of methotrexate+sulfasalazine+hydroxychloroquine, b/tsDMARD—biologic/targeted synthetic disease modifying anti-rheumatic drug.