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We read with interest the article by Mulherin et al concerning the protective nature of gold rings in 55 patients.1 At the end point of our prospective 20 year follow up study of 103 patients with recent (⩽6 months) seropositive rheumatoid arthritis, the mean Larsen grades of the MCP joints were: MCP I 1.1, MCP II 2.2, MCP III 1.9, MCP IV 1.3, MCP V 1.5 and of the PIP joints PIP II 0.7, PIP III 1.0, PIP IV 1.0, and PIP V 0.9.2 Thus, in our epidemiologically collected inception cohort, the MCP I and PIP II joints were least destructed. No statistically significant difference was found between any hand joints comparing left with right during the follow up.
We suppose that intra-articular pressure is least in MCP I and IV causing less destruction. The ring finger is protected by other fingers, and therefore a ring of soft metal has been used on that finger for thousands of years. Our opinion is that the sometimes excellent effect of gold treatment is based on the SO− group of gold compounds, as is the case with penicillamine. Anyway, exchanging a golden ring with the opposite sex has a positive emotional effect.
Professor Boloşiu’s observations are of some interest and we were not aware of his previous publication in which he describes a similar case where sparing was noted in association with the use of a gold ring noting that in his case radiological sparing was noted in the ring associated PIPJs.
Whether this would argue against a local effect of gold through lymphatic drainage or an alternative protective mechanical explanation would be difficult to assess.
Clearly we would agree with Professor Boloşiu that a mechanical explanation cannot be ruled out.
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