Combinations of disease-modifying antirheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis (RA) have been recently advocated. Efficacy and toxicity data are scant. We conducted a survey of Alabama rheumatologists to determine actual practice patterns regarding combined DMARD treatment for their patients with RA. No differences were found between academic and nonacademic rheumatologists nor between users and nonusers of combination DMARDs in demograpahics or practice pattern profiles. The majority did report use of combination DMARD treatment, though only in a small proportion of their patients for whom the pyramid approach had failed. The combination most often employed was gold salts and antimalarials. Users, as compared to nonusers, did favor changing the classic pyramid approach for the treatment of RA, but the differences did not reach statistical significance.