Læknablaðið : fylgirit - 01.05.1978, Page 35

than in the penicillamine group. After 6 months
treatment all the mean values had decreased in
both groups.
Table VI presents the mean levels of serum
immunoglobulins IgG, IgM and IgA before and
after treatment. Before treatment IgG and IgM
values were on the average slightly lower in the
gold group than in the penicillamine group. After
6 months treatment the mean serum levels of
IgM had decreased both in the penicillamine and
in the gold group. A slight decrease could be
seen in the mean level of IgA in the penicillamine
group and a clear decrease in the gold group.
Side effects:
Side effects causing discontinuation of the
treatment were observed during the follow-up
period only in one case in the penicillamine
group. After 2 weeks medication one penicil-
lamine patient ran a temperature of 37,5 -
38,2°C. The treatment was stopped and the
fever disappeared in a few days. In the gold
group, treatment had to be discontinued in one
case because of proteinuria, in one because of
a moderate hematuria and in one case because
of rash. AU these side effects disappeared
after discontinuation of the treatment.
Even if the difference in the mean activity of the
disease was not very prominent, it may have had
some infiuence on the results in favour of gold.
Therefore and because of the so far small size
of the material no far-reaching conclusions can
be made at this stage of the study.
The decrease in mean number of affected
joints, and the changes in E.S.R. and hemo-
globin values in both groups is clearly an
evidence that both the patients treated with
penicillamine and those treated with gold have
improved. The decrease in plasma fibrinogen,
orosomucoid and ceruloplasmin in both groups
also indicates a decrease in the activity of the
disease. In the group treated with penicillamine
the rheumatoid factor titre fell significantly in 9
out of 13 originally seropositive cases; in the
group treated with gold this occured in only 2 out
og 4 cases. The serum level of IgM however
decreased equally in both groups and the level
of IgA especially in the gold group.
At this stage of the study penicillamine and
gold treatment appear to be equally effective in
the management of early rheumatoid arthritis.
The serological findings could possibly be
explained merely as a result of a decrease in
the inflammatory activity of the rheumatoid
process itself without implicating a direct
immunosuppressive effect of the drugs.
Conclusions:
A comparison reveals that the disease of the
47 cases reported here happened to be on an
average slightly milder in the patients treated
with gold than in those treated with penicillamine.
Acknowledgements:
The penicillamine preparation used
(Reumacillin R) was received from Medica &
Co., Helsinki, Finland. Financial support for
the study was furnished by the same company.
Table I. Clinical and diagnoatic features before treatment with
penicillaraine or gold
Penicillamine treatment Qðld treatment
Number of cases Mean - S.D. (Range) Number of cases Mean - S.D. (Range)
Total of patients 25 (23) 22 (19)
Males 4 1
Females 21 20
Age (years) 42.6 - 11.4 42.6 í 10.1
(20-67) (27-59)
Duration of disease 15.6 - 8.6 19.9 i 14.5
(months) (6-36) (2-36)
Waaler-Rose test
Titre í 64 11 17
Titre J 64 14 5
E.S.R. (mm/1 hour) 58.5 i 33.3 40.4* - 23.6
! (8-124) (7-86)
Hemoglqbin (g/1) 120.7 - 13.2 129.2* í 12.3
(96-150) (98-146)
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