The aim of this study was to investigate the effects of changes in treatment of patients with RA on disease activity measured by DAS28. Therefore we investigated the data of 318 treatment changes in the rheumatologic outpatient department of the university hospital in Halle(Saale) in the period between 2005 and 2009. The greatest decrease in DAS28 occurred after initiation of combination therapy with a TNF-inhibitor (2,3 +1,2 (n=20)). Compared with the impact of TNF-inhibitor treatment, no significant difference in DAS28 reduction after initiation of therapy with a combination of synthetic DMARD could be seen (1,9+1,0 (n=21)). All other types of therapy changes showed a significant lower reduction in DAS28 compared to a combination therapy with a TNF-inhibitor (p value 0,002-0,022). The DAS28 reduction was 0,77 to 0,98 lower than after initiation of a combination treatment with TNF antagonists. The results emphasize the significance of combination therapies in daily clinical practice.