title: Progression of joint damage in early active severe rheumatoid arthritis during 18 months of treatment: comparison of low-dose cyclosporin and parenteral gold.
abstract: OBJECTIVE
  This study compared the progression of joint damage in patients with early active severe rheumatoid arthritis (RA) treated with cyclosporin or parenteral gold.
  
  
  METHODS
  In this open, randomized, multicentre study with a blinded radiological endpoint, 375 patients who had suffered from active severe RA for <3 yr were randomized to be treated for 18 months with low-dose cyclosporin or parenteral gold. The groups were stratified with regard to corticosteroid use. Primary efficacy variables were numbers of erosions, erosion score and the Larsen-Dale joint damage score.
  
  
  RESULTS
  Joint damage progressed at similar rates in both treatment arms. In both groups, patients receiving corticosteroids had less X-ray progression. Rheumatoid factor positivity, high swollen joint count, high erythrocyte sedimentation rate and pre-existing X-ray abnormalities predicted progression of joint damage. Although numbers of serious adverse events were similar, more gold patients (n = 65) than cyclosporin patients (n = 45) withdrew from study medication because of adverse events.
  
  
  CONCLUSIONS
  Cyclosporin was comparable to parenteral gold in retarding progression of joint damage and was better tolerated in terms of adherence to therapy. The open label design should be kept in mind when assessing this difference.
authors.affiliation: Medizinische Hochschule Hannover, Division of Rheumatology, Germany.
authors.forename: H K
authors.initials: HK
authors.lastname: Zeidler
authors.forename: T K
authors.initials: TK
authors.lastname: Kvien
authors.forename: P
authors.initials: P
authors.lastname: Hannonen
authors.forename: F A
authors.initials: FA
authors.lastname: Wollheim
authors.forename: O
authors.initials: O
authors.lastname: Førre
authors.forename: H
authors.initials: H
authors.lastname: Geidel
authors.forename: I
authors.initials: I
authors.lastname: Hafström
authors.forename: J P
authors.initials: JP
authors.lastname: Kaltwasser
authors.forename: M
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.forename: B
authors.initials: B
authors.lastname: Manger
authors.forename: L
authors.initials: L
authors.lastname: Laasonen
authors.forename: E R
authors.initials: ER
authors.lastname: Markert
authors.forename: H
authors.initials: H
authors.lastname: Prestele
authors.forename: P
authors.initials: P
authors.lastname: Kurki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016572:Cyclosporine / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D006052:Gold Sodium Thiomalate / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents; D006052:Gold Sodium Thiomalate; D016572:Cyclosporine