Combination therapy with hydroxychloroquine, gold sodium thiomalate and methotrexate in early rheumatoid arthritis. An open 3-year study

During recent years, aggressive therapeutic approaches have been proposed i n order to control the Rheumatoid Arthritis (RA) activity and to avoid join t destruction. Here we report the results of an open 3-year trial on the co mbination of three second-line drugs, hydroxychloroquine (HCQ), methotrexat e (MTX) and gold sodium thiomalate (GST), in early active RA. Four men and 17 women were enrolled in the study and were treated during the first year with HCQ 400 mg/day, GST 50 mg/week and oral MTX 7.5 mg/week; during the se cond and the third years the doses of HCQ and MTX were reduced to 200 mg/da y and 5 mg/week, respectively; the interval between the GST injections was progressively increased until 4 weeks. Prednisone at an initial dose not hi gher than 10 mg/day was associated. Sulindac was allowed. Eight patients le ft the study because of side-effects, 2 patients abandoned the study, 12 pa tients compleated the 3 years of treatment. We obtained a significant and e arly amelioration of both clinical and laboratory parameters during the fir st year; in the two subsequent years the positive results were maintained. In our opinion the most significant result is the absence of anatomical pro gression in 10 out of 12 patients, even if a more prolonged observation is necessary to obtain more reliable data.