methotrexate + sulfasalazine + azathioprine

This is a combination therapy consisting of three conventional disease-modifying antirheumatic drugs (DMARDs): methotrexate, sulfasalazine, and azathioprine. Each drug acts as an immunosuppressant or anti-inflammatory agent to reduce immune-mediated joint inflammation and slow the progression of diseases such as rheumatoid arthritis. Methotrexate inhibits dihydrofolate reductase, interfering with DNA synthesis and immune cell proliferation. Sulfasalazine's mechanism is not fully understood but involves inhibition of inflammatory mediators after its breakdown into mesalazine and sulfapyridine in the gut. Azathioprine is a purine analog that suppresses B- and T-cell function by inhibiting purine synthesis[6][10][8]. This triple DMARD regimen may be considered for patients with inadequate response to single or double DMARD therapy, particularly in severe or refractory cases of autoimmune diseases like rheumatoid arthritis[1][4].