The British Journal of Rheumatology, Vol 37, 1220-1226, Copyright © 1998 by British Society for Rheumatology
R Rau, G Herborn, H Menninger and O Sangha
OBJECTIVE: To compare radiographic outcomes in patients with active early
erosive rheumatoid arthritis (RA) who were treated with methotrexate (MTX)
and gold sodium thiomalate (GSTM). METHODS: A total of 174 patients from
two centres were randomly assigned to receive weekly i.m. injections for 12
months of either 15 mg MTX or 50 mg GSTM in a double-blind fashion.
Radiographic evaluations including standardized scoring of 38 joints of the
hands, wrists and forefeet, and count of eroded joints, were carried out at
baseline and after 6 and 12 months in all patients, including withdrawals.
RESULTS: An intention-to-treat analysis revealed no statistically
significant difference in the progression of radiographic scores between
treatment groups after 6 months (3.4 with MTX vs 2.6 with GSTM, P = 0.66)
and after 12 months (6.0 vs 4.8, P = 0.44). A similar pattern was observed
for the number of joints with erosions. The slope of radiographic
progression was significantly reduced in the second half-year compared to
the first 6 months in both groups. Erythrocyte sedimentation rate and
C-reactive protein at baseline, and the presence of rheumatoid factor (RF),
were the main predictors of progression in bivariate analysis. RF remained
as the only predictor for radiographic outcome in multivariable analysis.
CONCLUSION: In parallel to clinical improvement, both GSTM and MTX reduce
the slope of radiographic progression in patients with active erosive RA.
ORIGINAL PAPERS
Progression in early erosive rheumatoid arthritis: 12 month results from a randomized controlled trial comparing methotrexate and gold sodium thiomalate
Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Munich, Germany.
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