Extended report
Comparative study of intramuscular gold and methotrexate in a
rheumatoid arthritis population from a socially deprived area
J Hamiltona, I B McInnesa, E A Thomsonb, D Porterb, J A Hunterb, R Madhoka, H A Capella
a Centre for Rheumatic
Diseases, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4
0SF, United Kingdom, b Gartnaval General
Hospital, Great Western Road, Glasgow, United Kingdom
Correspondence to: Dr Hamilton jendh{at}emailmsn.com
Accepted for publication 15 December
2000
OBJECTIVE
To compare
the risk-benefit ratio of intramuscular gold (gold sodium thiomalate
(GST)) and methotrexate (MTX) in a population with rheumatoid arthritis
(RA) from a deprived area.
METHODSPatients with
active RA were randomly assigned to open treatment with GST or MTX.
Clinical and laboratory assessment was performed at 0, 12, 24, and 48 weeks. Results were analysed on an intention to treat basis.
RESULTS141 patients
were recruited72 were randomly allocated to GST and 69 to MTX. There
were no statistically significant differences found in either the
clinical or demographic variables at baseline. At 48 weeks 31 (43%)
patients continued to receive GST and 43 (62%) MTX. The median MTX
dose achieved was 10 mg. Gold caused significantly more withdrawals for
toxicity (43% GST v 19% MTX, p=0.0026, log
rank test). Both groups experienced a significant improvement in
erythrocyte sedimentation rate, C reactive protein, Ritchie Articular
Index, and pain score by 24 weeks (p<0.001, Friedman test). Although a
trend towards an improved Health Assessment Questionnaire (HAQ) score
and global wellbeing was seen in both groups, this did not reach
statistical significance. No differences in efficacy were found when
the two groups were compared (Mann-Whitney).
CONCLUSIONGST and low
dose MTX showed equivalent efficacy, but toxicity was more common in
patients treated with GST. GST, although more toxic, remains a useful
alternative for patients in whom MTX is contraindicated.
© 2001 by Annals of the Rheumatic Diseases
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