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Logo of annrheumdAnnals of the Rheumatic DiseasesCurrent TOCInstructions for authors
Ann Rheum Dis. Feb 1998; 57(2): 88–93.
PMCID: PMC1752531

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

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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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bensen WG, Bensen W, Adachi JD. Back to the future: the pyramids of rheumatoid arthritis. J Rheumatol. 1997 Jun;24(6):1023–1027. [PubMed]
  • Wolfe F, Hawley DJ, Cathey MA. Clinical and health status measures over time: prognosis and outcome assessment in rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1290–1297. [PubMed]
  • Fries JF, Williams CA, Ramey D, Bloch DA. The relative toxicity of disease-modifying antirheumatic drugs. Arthritis Rheum. 1993 Mar;36(3):297–306. [PubMed]
  • Emery P, Salmon M. Early rheumatoid arthritis: time to aim for remission? Ann Rheum Dis. 1995 Dec;54(12):944–947. [PMC free article] [PubMed]
  • Wolfe F, Kleinheksel SM, Cathey MA, Hawley DJ, Spitz PW, Fries JF. 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]
  • Leigh JP, Fries JF. Mortality predictors among 263 patients with rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1307–1312. [PubMed]
  • Sigler JW, Bluhm GB, Duncan H, Sharp JT, Ensign DC, McCrum WR. Gold salts in the treatment of rheumatoid arthritis. A double-blind study. Ann Intern Med. 1974 Jan;80(1):21–26. [PubMed]
  • 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. [PubMed]
  • ROPES MW, BENNETT GA, COBB S, JACOX R, JESSAR RA. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • Sherrer YS, Bloch DA, Mitchell DM, Young DY, Fries JF. The development of disability in rheumatoid arthritis. Arthritis Rheum. 1986 Apr;29(4):494–500. [PubMed]
  • 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]
  • Wolfe F, Cathey MA. The assessment and prediction of functional disability in rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1298–1306. [PubMed]
  • Möttönen TT. Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis. 1988 Aug;47(8):648–653. [PMC free article] [PubMed]
  • Fuchs HA, Kaye JJ, Callahan LF, Nance EP, 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]
  • van der Heijde DM, van Leeuwen MA, van Riel PL, van de Putte LB. 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]
  • Kaarela K, Kautiainen H. Continuous progression of radiological destruction in seropositive rheumatoid arthritis. J Rheumatol. 1997 Jul;24(7):1285–1287. [PubMed]
  • Tunn EJ, Bacon PA. Differentiating persistent from self-limiting symmetrical synovitis in an early arthritis clinic. Br J Rheumatol. 1993 Feb;32(2):97–103. [PubMed]
  • Young A. Short-term outcomes in recent-onset rheumatoid arthritis. Br J Rheumatol. 1995 Nov;34 (Suppl 2):79–86. [PubMed]
  • 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]
  • Situnayake RD, 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]
  • Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990 Oct;33(10):1449–1461. [PubMed]
  • Epstein WV. Parenteral gold therapy for rheumatoid arthritis: a treatment whose time has gone. J Rheumatol. 1989 Oct;16(10):1291–1294. [PubMed]
  • Harrison BJ, Symmons DP, Brennan P, Bankhead CR, Barrett EM, Scott DG, Silman AJ. 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]

Figures and Tables

Figure 1
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
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
Reasons for withdrawal of gold treatment (n=280).
Figure 4
Survival curves for remaining on gold treatment. Group 1= 0-2 years, group 2= >2-5 years, and group 3= >5 years.

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