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Centre for Rheumatic
Diseases, Royal Infirmary, Glasgow
Correspondence to: Dr R Munro, Centre for Rheumatic Diseases, Wards 14/15, Royal Infirmary, Glasgow G4 0SF.
Accepted for publication 13 January 1998
OBJECTIVE
To determine whether there is a relation
between disease duration and functional outcome in patients with
rheumatoid arthritis (RA) treated with intramuscular sodium
aurothiomolate (gold) for five years.
METHODS440 patients with RA were enrolled in a
prospective trial of gold treatment. Initial demographic details were
recorded. Disease activity was assessed at yearly intervals using a
combination of clinical (pain score, Ritchie articular index, duration
of morning stiffness) and laboratory (erythrocyte sedimentation rate, C
reactive protein) parameters. Change in functional status was assessed
using the health status questionnaire (HAQ). Patients were stratified
according to disease duration at outset (group 1= 0-2 years n=106,
group 2 = >2-5 years n=93, and group 3= >5 years n=235).
RESULTSThere were no significant differences
between the groups at outset. A total of 160 patients completed five
years of treatment (group 1 n=44 (42%), group 2 n=37 (40%), and group
3 n=79 (34%)). Patients in group 1 had a significantly lower HAQ from
year 1 to year 5 with a mean improvement of 30% at the end of the
study (p<0.001). Neither group 2 nor group 3 had a significant change in their HAQ at study end. There were significant improvements in all
other variables (p<0.05) in each group apart from pain in group 2.
CONCLUSIONPatients with early RA have a larger
reversible component to their HAQ. Only patients with disease duration
of up to two years have a longlasting improvement in their functional
ability after starting intramuscular gold treatment.
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