PROGRESSION OF JOINT DAMAGE IN EARTH ACTIVE SEVERE RHEUMATOID-ARTHRITIS DURING 18 MONTHS OF TREATMENT - COMPARISON OF LOW-DOSE CYCLOSPORINEAND PARENTERAL GOLD

Objective This study compared the progression of joint damage in patie nts with early active seven rheumatoid arthritis (RA) treated with cyc losporin or parenteral gold. Methods. In this open, randomized, multic entre study with a blinded radiological endpoint, 375 patients who had suffered from active severe RA for < 3 yr were randomized to be treat ed for 18 months with low-dose cyclosporin or parenteral gold. The gro ups were stratified with regard to corticosteroid use. Primary efficac y variables were numbers of erosions, erosion score and the Larsen-Dal e joint damage score. Results. Joint damage progressed at similar rate s in both treatment arms. In both groups, patients receiving corticost eroids had less X-ray progression. Rheumatoid factor positivity, high swollen joint count, high erythrocyte sedimentation rate and pre-exist ing X-ray abnormalities predicted progression of joint damage. Althoug h numbers of serious adverse events were similar, more gold patients ( n = 65) than cyclosporin patients (n = 45) withdrew from study medicat ion because of adverse events. Conclusion. Cyclosporin was comparable to parenteral gold in retarding progression of joint damage and was be tter tolerated in terms of adherence to therapy. The open label design should be kept in mind when assessing this difference.