Læknablaðið : fylgirit - 01.05.1978, Page 34

P. 'viakisara. M. Nissila, A. Kajander,
J. Martic, R. von Essen and Greta-Lisa
Makisara
Rheumatism Poundation Hospital, Heinola, Finland
In February 1975, a comparative study oi
penicillamine and gold treatment in relatively
early cases of rheumatoid arthritis was started
at the Rheumatism Foundation Hospital. A series
of altogether 100 patients will be collected.
Assigning the patients at random by lot, half of
them will be treated with penicillamine and half
with gold. The entire duration of the treatment
will be one year. At the present time there are
84 patients in the series. In this paper a
preliminary report on the results of 6 months
follow-up in 47 patients will be given.
Patients aur) melhods:
Patients with active rheumatoid arthritis of at
most 3 years duration are taken to the trial. The
diagnosis of rheumatoid arthritis must be verified
and at leasi 5 ARA-criteria fuHfiUed. Patients
with past or present renal or liver disease,
blood disease or blood dyscrasia caused by drugs
and patients with allergic disease or penicillin
allergy are excluded from the series. Patients
who have earlier had peniciUamin or gold treat-
ment are also left out. The whole series of
100 patients will be selected from patients
admitted co Rheumatism Foundation Hospital and
the treatment will in all cases be started in the
hospital. Before starting the medication, clini-
cal, laboratory, and x-ray examinations are
performed. AU the patients are treated for 6-8
weeks in ihe hospital, and for the rest of the
time as out-patients. The first clinical control
is performed at the out-patient clinic of Rheuma-
tism Foundation Hospital after 3 months treat-
ment and the further controls are performed
with 3 months intervals. In order to detect
possible side effects laboratory examination of
blood and urine are done weekly while in the
hospital, and subsequently monthly. Control
x-ray investigations will be made one year after
the start of treatment.
Medication:
The dosage of penicillamine is as follows: lst
week 150 mg daily, 2nd week 300 mg daily, 3rd
week 450 mg daily, 4th week and after that 600
mg daily. In gold treatment sodium-aurothioma-
COMPARISON OF PENICILLAMINE
AND GOLD TREATMENT IN
RHEUMATOID ARTHRITIS
A preliminary report
xale is used. The treatmeni ts started with
increasing doses 10-20-30-50 mg weekly and
continued with 50 mg once a week up to a totai
dose of 13 mg per kilogram; thereafter 50 mg
once a month is given. No corticosteroid treat-
ment is given.
R es ults :
The baseline data of the first 47 patients in
the trial are shown in Table I. Some small
differences between the groups can be seen.
There are fewer stage UI cases and proportionally
more seronegative cases in gold treatment group
than in the penicillamine group. The average
E.S.R. was slightly lower and the mean hemo-
globin content was slightly higher in the gold
group than in the penicillamine group. (The
P-values of the differences of the means are
signed as follows: XP<0.05, XP<0. 01 , XP<0. 001.)
Table II shows the changes in clinical
findings after 6 months treatment. Before treat-
ment the average number of affected joints was
slightly higher, and the duration of morning
stiffness slightly longer in the penicillamine
group than in the gold group. The average grip
strength was slightly better in the gold group.
The number of joints showing symptoms and
also the mean duration of morning stiffness
decreased to some extent during the foUow-up
period. In both groups the mean values of grip
strength increased but not statistically signifi-
cantly. The changes in clinical joint findings
were about of the same order in both groups.
The changes in E.S.R. and hemoglobin content
are presented inTable III. A significant
E.S.R. decrease and an increase of hemoglobin
value can be seen. All these changes are about
of the same order in both groups.
Table IV shows the changes in rheumatoid
factor titres for both groups. In the penicil-
lamine group the titres decreased significantly
in 9 out of 13 cases, in the gold group in 2 cases
out of 4.
The mean levels of plasma fibrinogen,
orosomucoid ceruloplasmin for both groups are
shown in Table V. Before treatment aU
these values were a little lower in the gold group
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