Læknablaðið : fylgirit - 01.05.1978, Page 21

Heinola Study Group FOLLOW-UP STUDY OF
RHEUMATOID ARTHRITIS
PATIENTS TREATED WITH
GOLD, CHLOROQUINE, OR
COMBINED GOLD AND STEROID
Since many years gold and chloroquine have
been important drugs in the treatment of rheuma-
toid arthritis. Comparison between these has
been rather infrequent. Corticosteroids have been ,
used in the rheumatoid arthritis generally as an
additional drug in more severe cases. There
has been some doubt about weakening of results
of gold treatment, if gold and steroid are given
at the same time. Thus in this study gold,
chloroquine, and combined gold and stersid were
chosen for comparison.
It is evident that these kind of drugs or perhaps
any drugs cannot entirely heal patients with
irreversible joint changes. On the other hand
it is rather difficult to find fresh arthritis cases
for this type of drug trial, because it is not often
possible to confirm the diagnosis of rheumatoid
arthritis before follow-up of several months or
even years. This study has, however, been done
with patients who have at a very early stage of
disease undergone all available clinical, laboratory,
and x-ray examinations to find out any other reason
for arthritic symptoms than rheumatoid arthritis.
The whole material, of which these patients are a
sample, has been presented here by Isomaki. The
treatment was started in six month's time after
the appearing of joint symptoms. The drugs for
the patients were chosen according to the date of
birth, which is not perhaps the best way of
randomization. A blind trial would, however,
have been impossible. The evaluation was done
after one year's treatment, and if the diagnosis
turned out to be wrong, the patient was taken out
of the trial material.
The dosage of the drugs was conventional.
Gold was given as sodiumaurothiomalate, known
as Myocrisin, at weekly intervals about 15 times
until a total dose of 800 mg was achieved, and
50 mg monthly was continued then.. The chloro-
quine group got hydroxychloroquine about 5 mg
per kilogram daily. Those patients with
combined gold and steroid treatment had the
same amount of gold as those with only gold and
additionally prednisolone 5-10 mg every other
day or daily, if required. All patients had
sufficient amount of non-steroidal anti-inflamma-
tory analgesics, usually salicylates.
At this stage our study comprises 85 patients.
Table 1 gives some information about them. The
three treatment groups were of rather the same
size. The treatment of the fourth group was
discontinued because of complications. Gold was
the reason for discontinuation also in the group
with steroid. AU complications were mild and
reversible: rashes, proteinuria and slight blood
changes, one gastrointestinal irritation in the
chloroquine group. AU patients met at least
three of the American Rheumatism Association
criteria for rheumatoid arthritis, most of them
met five, and as I said; exclusion of other
arthritic diseases was as efficient as possible.
In age and titre of rheumatoid faetor there are
some differences but they are not statistically
significant.
Before the beginning of the treatment three
indexes based on the clinical examination were
compUed. These figures, which are shown as
mean values in the table 2, indicate the severity
of the patient's disease. The indexes for joint
tenderness and sweUing are the number of
affected joints. However, the small joints, for
instance pip-j oints, of one hand or foot are
regarded as one joint. Functional disabUity was
determined according to 20 tests performed to
the patient. Some non-significant differences
between the groups were found before the treat-
ment.
After one year the same evaluation was done
again. All three treatment groups were defi-
nitely better. The crosses are indicating signifi-
cant improvement of the mean values at the
five per cent level. However, when the groups
were compared tö each other, there were no
significant differences between any of the four
groups.
It has been said that chronic rheumatoid arthri-
tis wUl seldom be healed completely. It was
interesting to see, however, how many patients
of this type of patient material became totaUy
symptomless during the one year follow-up. In
the table 3 you will find numbers of patients who
had total remission, 25 patients out of 85 were
without any joint symptoms or findings. In the
two groups treated with gold the remission was
most frequent, about 40 per cent. The differ-
ences are not significant but the five per cent
19