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. 1998 Feb;57(2):88–93. doi: 10.1136/ard.57.2.88

Improved functional outcome in patients with early rheumatoid arthritis treated with intramuscular gold: results of a five year prospective study

R Munro 1, R Hampson 1, A McEntegart 1, E Thomson 1, R Madhok 1, H Capell 1
PMCID: PMC1752531  PMID: 9613337

Abstract

OBJECTIVE—To determine whether there is a relation between disease duration and functional outcome in patients with rheumatoid arthritis (RA) treated with intramuscular sodium aurothiomolate (gold) for five years.
METHODS—440 patients with RA were enrolled in a prospective trial of gold treatment. Initial demographic details were recorded. Disease activity was assessed at yearly intervals using a combination of clinical (pain score, Ritchie articular index, duration of morning stiffness) and laboratory (erythrocyte sedimentation rate, C reactive protein) parameters. Change in functional status was assessed using the health status questionnaire (HAQ). Patients were stratified according to disease duration at outset (group 1= 0-2 years n=106, group 2 = >2-5 years n=93, and group 3= >5 years n=235).
RESULTS—There were no significant differences between the groups at outset. A total of 160 patients completed five years of treatment (group 1 n=44 (42%), group 2 n=37 (40%), and group 3 n=79 (34%)). Patients in group 1 had a significantly lower HAQ from year 1 to year 5 with a mean improvement of 30% at the end of the study (p<0.001). Neither group 2 nor group 3 had a significant change in their HAQ at study end. There were significant improvements in all other variables (p<0.05) in each group apart from pain in group 2.
CONCLUSION—Patients with early RA have a larger reversible component to their HAQ. Only patients with disease duration of up to two years have a longlasting improvement in their functional ability after starting intramuscular gold treatment.

 Keywords: gold; rheumatoid arthritis; function; HAQ

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Figure 1  .

Figure 1  

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Median change in HAQ over five years stratified according to initial disease duration. Group 1= 0-2 years, group 2= >2-5 years, and group 3= >5 years.

Figure 2  .

Figure 2  

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Median change in laboratory and clinical markers of disease activity over five years stratified according to initial disease duration. Group 1= 0-2 years, group 2= >2-5 years, and group 3= >5 years.

Figure 3  .

Figure 3  

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Reasons for withdrawal of gold treatment (n=280).

Figure 4  .

Figure 4  

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Survival curves for remaining on gold treatment. Group 1= 0-2 years, group 2= >2-5 years, and group 3= >5 years.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bensen W. G., Bensen W., Adachi J. D. Back to the future: the pyramids of rheumatoid arthritis. J Rheumatol. 1997 Jun;24(6):1023–1027. [PubMed] [Google Scholar]
  2. Egsmose C., Lund B., Borg G., Pettersson H., Berg E., Brodin U., Trang L. Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year followup of a prospective double blind placebo controlled study. J Rheumatol. 1995 Dec;22(12):2208–2213. [PubMed] [Google Scholar]
  3. Emery P., Salmon M. Early rheumatoid arthritis: time to aim for remission? Ann Rheum Dis. 1995 Dec;54(12):944–947. doi: 10.1136/ard.54.12.944. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Epstein W. V. Parenteral gold therapy for rheumatoid arthritis: a treatment whose time has gone. J Rheumatol. 1989 Oct;16(10):1291–1294. [PubMed] [Google Scholar]
  5. Felson D. T., Anderson J. J., Meenan R. F. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990 Oct;33(10):1449–1461. doi: 10.1002/art.1780331001. [DOI] [PubMed] [Google Scholar]
  6. Fries J. F., Spitz P., Kraines R. G., Holman H. R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. doi: 10.1002/art.1780230202. [DOI] [PubMed] [Google Scholar]
  7. Fries J. F., Williams C. A., Ramey D., Bloch D. A. The relative toxicity of disease-modifying antirheumatic drugs. Arthritis Rheum. 1993 Mar;36(3):297–306. doi: 10.1002/art.1780360303. [DOI] [PubMed] [Google Scholar]
  8. Fuchs H. A., Kaye J. J., Callahan L. F., Nance E. P., Pincus T. Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease. J Rheumatol. 1989 May;16(5):585–591. [PubMed] [Google Scholar]
  9. Hakala M., Nieminen P., Koivisto O. More evidence from a community based series of better outcome in rheumatoid arthritis. Data on the effect of multidisciplinary care on the retention of functional ability. J Rheumatol. 1994 Aug;21(8):1432–1437. [PubMed] [Google Scholar]
  10. Harrison B. J., Symmons D. P., Brennan P., Bankhead C. R., Barrett E. M., Scott D. G., Silman A. J. Inflammatory polyarthritis in the community is not a benign disease: predicting functional disability one year after presentation. J Rheumatol. 1996 Aug;23(8):1326–1331. [PubMed] [Google Scholar]
  11. Kaarela K., Kautiainen H. Continuous progression of radiological destruction in seropositive rheumatoid arthritis. J Rheumatol. 1997 Jul;24(7):1285–1287. [PubMed] [Google Scholar]
  12. Leigh J. P., Fries J. F. Mortality predictors among 263 patients with rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1307–1312. [PubMed] [Google Scholar]
  13. Luukkainen R., Kajander A., Isomäki H. Effect of gold on progression of erosions in rheumatoid arthritis. Better results with early treatment. Scand J Rheumatol. 1977;6(3):189–192. doi: 10.3109/03009747709095448. [DOI] [PubMed] [Google Scholar]
  14. Möttönen T. T. Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis. 1988 Aug;47(8):648–653. doi: 10.1136/ard.47.8.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. ROPES M. W., BENNETT G. A., COBB S., JACOX R., JESSAR R. A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed] [Google Scholar]
  16. Sherrer Y. S., Bloch D. A., Mitchell D. M., Young D. Y., Fries J. F. The development of disability in rheumatoid arthritis. Arthritis Rheum. 1986 Apr;29(4):494–500. doi: 10.1002/art.1780290406. [DOI] [PubMed] [Google Scholar]
  17. Sigler J. W., Bluhm G. B., Duncan H., Sharp J. T., Ensign D. C., McCrum W. R. Gold salts in the treatment of rheumatoid arthritis. A double-blind study. Ann Intern Med. 1974 Jan;80(1):21–26. doi: 10.7326/0003-4819-80-1-21. [DOI] [PubMed] [Google Scholar]
  18. Situnayake R. D., McConkey B. Clinical and laboratory effects of prolonged therapy with sulfasalazine, gold or penicillamine: the effects of disease duration on treatment response. J Rheumatol. 1990 Oct;17(10):1268–1273. [PubMed] [Google Scholar]
  19. Tunn E. J., Bacon P. A. Differentiating persistent from self-limiting symmetrical synovitis in an early arthritis clinic. Br J Rheumatol. 1993 Feb;32(2):97–103. doi: 10.1093/rheumatology/32.2.97. [DOI] [PubMed] [Google Scholar]
  20. Wolfe F., Cathey M. A. The assessment and prediction of functional disability in rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1298–1306. [PubMed] [Google Scholar]
  21. Wolfe F., Hawley D. J., Cathey M. A. Clinical and health status measures over time: prognosis and outcome assessment in rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1290–1297. [PubMed] [Google Scholar]
  22. Wolfe F., Kleinheksel S. M., Cathey M. A., Hawley D. J., Spitz P. W., Fries J. F. The clinical value of the Stanford Health Assessment Questionnaire Functional Disability Index in patients with rheumatoid arthritis. J Rheumatol. 1988 Oct;15(10):1480–1488. [PubMed] [Google Scholar]
  23. Young A. Short-term outcomes in recent-onset rheumatoid arthritis. Br J Rheumatol. 1995 Nov;34 (Suppl 2):79–86. [PubMed] [Google Scholar]
  24. van der Heijde D. M., van Leeuwen M. A., van Riel P. L., van de Putte L. B. Radiographic progression on radiographs of hands and feet during the first 3 years of rheumatoid arthritis measured according to Sharp's method (van der Heijde modification). J Rheumatol. 1995 Sep;22(9):1792–1796. [PubMed] [Google Scholar]

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