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© 1989 British Society for Rheumatology

research-article

COMBINATION THERAPY WITH GOLD AND HYDROXYCHLOROQUINE IN RHEUMATOID ARTHRITIS: A PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED STUDY

D. L. SCOTT1,*, P. T. DAWES{dagger}, E. TUNN{ddagger}, P. D. FOWLER{dagger}, M. F. SHADFORTH{dagger}, J. FISHER{dagger}, S. CLARKE{dagger}, M. COLLINS{dagger}, P. JONES, A. J. POPERT and P. A. BACON{ddagger}

*St Bartholomew's and Homerton Hospitals London
{dagger}Staffordshire Rheumatology Centre Stoke
{ddagger}Department of Rheumatology, Birmingham University
Highfield Hospital Droitwich

Correspondence to: 1Correspondence to: Dr. D. L. Scott, Department of Rheumatology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE.

We studied combination therapy with two slow-acting antirheumatic drugs given concurrently in active rheumatoid arthritis (RA). A 12-month prospective randomized controlled trial compared gold and hydroxychloroquine in 52 patients to gold and placebo in 49. The patients continued to receive non-steroidal anti-inflammatory drugs and analgesics. They were selected from three rheumatology centres in the West Midlands. Combination therapy led to a greater number of withdrawals due to adverse reactions (18 cases compared to 10 receiving gold/placebo). Patients completing 12 months' therapy (27 taking gold/ hydroxychloroquine and 32 on gold/placebo) were compared using five clinical, seven laboratory, and one radiological measure. All 13 variables favoured gold/hydroxychloroquine with an overall advantage of 20–25% for the combination. This only reached statistical significance (at the 1% level) for C-reactive protein. An overall disease activity index was better at 12 months (at the 5% level) and showed a more rapid response with gold/hydroxychloroquine. This is the first randomized prospective placebo-controlled trial to show a significant advantage from a combination of two slow-acting drugs. There are many different ways of giving such combinations and we consider these should be explored to maximize the effectiveness of treatment for RA.

KEY WORDS: Rheumatoid arthritis, Treatment, Antimalarials, Sodium aurothiomalate


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