THE EFFECTS OF DRUG-THERAPY ON RADIOGRAPHIC PROGRESSION OF RHEUMATOID-ARTHRITIS - RESULTS OF A 36-WEEK RANDOMIZED TRIAL COMPARING METHOTREXATE AND AURANOFIN

Objective. To determine the effects of drug therapy (methotrexate [MTX ] versus auranofin [AUR]) on radiographic progression in patients with active rheumatoid arthritis (RA). Methods. We conducted a 9-month ran domized, multicenter, double-blind trial comparing MTX and AUR. Standa rdized radiographs of the hands and wrists were obtained at baseline a nd at completion of the study. Four experienced bone radiologists grad ed the radiographs for erosions, joint space narrowing, erosion healin g, and reparative bone formation. Results. Two hundred eighty-one pati ents were enrolled in the study. Radiographs were available on 167 of the 183 who completed the trial. After 9 months of therapy, there was a significantly greater worsening of the erosion score in the AUR grou p (mean +/- SEM change of 1.67 +/- 0.4) compared with the change in th e MTX group (0.60 +/- 0.3) (P = 0.040). There was also a significantly greater worsening of the joint space narrowing score in the AUR group compared with the MTX group (1.36 +/- 0.3 versus 0.42 +/- 0.2) (P = 0 .007). There was no difference demonstrated between groups in healing of erosions or in reparative bone formation. Conclusion. The rate of r adiographic progression in patients with RA, as measured by erosion sc ore and joint space narrowing score, was demonstrated to be lower in t hose treated with MTX, as compared with AUR, over a 36-week period.