bucillamine + methotrexate + prednisolone

This is a combination therapy consisting of three disease-modifying and anti-inflammatory drugs commonly used in the management of rheumatoid arthritis and other autoimmune or inflammatory conditions. - **Bucillamine** is a disease-modifying antirheumatic drug (DMARD) developed in Japan, structurally related to D-penicillamine, with antioxidant and immunomodulatory properties. It inhibits immune cell activation and reduces oxidative stress[1][3]. - **Methotrexate** is a folate antagonist that acts as an immunosuppressant by inhibiting dihydrofolate reductase, leading to reduced DNA synthesis in rapidly dividing cells such as lymphocytes. It is considered the anchor DMARD for rheumatoid arthritis[6][8][10]. - **Prednisolone** is a synthetic glucocorticoid corticosteroid that exerts potent anti-inflammatory and immunosuppressive effects by modulating gene expression through the glucocorticoid receptor. The combination may be used when monotherapy or dual therapy does not achieve adequate disease control, aiming for synergistic effects on inflammation reduction, immune modulation, and symptom relief.