Background The role of gold salts in the present therapy of rheumatoid arthritis (RA) remains controversial.
Objectives To analyse the clinical efficacy (according to ACR response criteria) of a therapeutic protocol, that includes sodium aurothiomalate as first option DMARD in patients with recent onset RA.
Methods All patients with RA (ACR diagnostic criteria) for less than two years disease duration and no previous DMARD therapy, attending our Rheumatology Units during 1998–99, have been included in a therapeutic protocol, in which the first administered DMARD was sodium aurothiomalate at a dose of 50 mg/week. According to the ACR response at 6 months (no improvement, ACR-20 or ACR-50) patients were treated with methotrexate (MTX) alone, aurothiomalate plus MTX or aurothiomalate alone, respectively. Low dose of steroids (< 10 mg/d of prednisone) were allowed and intraarticular therapy with triamcionolone hexacetonide was performed in large joint with persistent synovitis.
Results Forty seven (7M/40F) patients were included (age:54 ± 16 years; disease duration:10 ± 7 months; RF+:40(85%)). The percentages of ACR responders at 6 and 12 months were as shown at the Table 1. Twenty-four per cent of patients discontinued gold salts due to adverse events or inefficacy at 12 months. Aurothiomalate was continued in 61% of patients as monotherapy and in 15% of patients in combination with MTX.
Conclusion Gold salts still have an important role in RA treatment. The use of aurothiomalate should be taken into account in the present therapeutic strategies of patients with early RA.