cholecalciferol + hydroxychloroquine + methotrexate + sulfasalazine

This is a combination therapy consisting of four agents: - **Cholecalciferol** (vitamin D3), a dietary supplement used to prevent or treat vitamin D deficiency and support bone health. - **Hydroxychloroquine**, an antimalarial agent also classified as a disease-modifying anti-rheumatic drug (DMARD), commonly used in autoimmune diseases such as rheumatoid arthritis and lupus. It modulates immune activity, likely by interfering with antigen presentation and toll-like receptor signaling. - **Methotrexate**, a folic acid antagonist and cornerstone DMARD for rheumatoid arthritis, which exerts its anti-inflammatory effects primarily through inhibition of dihydrofolate reductase, leading to suppression of DNA synthesis in rapidly dividing cells, interruption of adenosine pathways, and immunomodulation[1][5]. - **Sulfasalazine**, another DMARD that reduces inflammation by modulating immune responses; it is often combined with methotrexate and/or hydroxychloroquine for enhanced efficacy in inflammatory arthritides[3][7]. Combination regimens involving methotrexate, sulfasalazine, and hydroxychloroquine—known as "triple therapy"—are well-established for the management of moderate-to-severe rheumatoid arthritis when monotherapy is insufficient[2][4][8]. Cholecalciferol may be added to support bone health or address comorbid vitamin D deficiency but is not itself considered a DMARD.