Comparative study of intramuscular gold and methotrexate in a rheumatoid arthritis population from a socially deprived area

Objective-To compare the risk-benefit ratio of intramuscular gold (gold sod ium thiomalate (GST)) and methotrexate (MTX) in a population with rheumatoi d arthritis (RA) from a deprived area. Methods-Patients with active RA were randomly assigned to open treatment wi th GST or MTX. Clinical and laboratory assessment was performed at 0, 12, 2 4, and 48 weeks. Results were analysed on an intention to treat basis. Results-141 patients were recruited-72 were randomly allocated to GST and 6 9 to MTX. There were no statistically significant differences found in eith er the clinical or demographic variables at baseline. At 48 weeks 31 (43%) patients continued to receive GST and 43 (62%) MTX. The median MTX dose ach ieved was 10 mg. Gold caused significantly more withdrawals for toxicity (4 3% GST v 19% MTX, p=0.0026, log rank test). Both groups experienced a signi ficant improvement in erythrocyte sedimentation rate, C reactive protein, R itchie Articular Index, and pain score by 24 weeks (p<0.001, Friedman test) . Although a trend towards an improved Health Assessment Questionnaire (HAQ ) score and global wellbeing was seen in both groups, this did not reach st atistical significance. No differences in efficacy were found when the two groups were compared (Mann-Whitney). Conclusion-GST and low dose MTX showed equivalent efficacy, but toxicity wa s more common in patients treated with GST. GST, although more toxic, remai ns a useful alternative for patients in whom MTX is contraindicated.