Progression of joint damage in early active severe rheumatoid arthritis during 18 months of treatment: comparison of low-dose cyclosporin and parenteral gold

OBJECTIVE: This study compared the progression of joint damage in patientswith early active severe rheumatoid arthritis (RA) treated with cyclosporinor parenteral gold. METHODS: In this open, randomized, multicentre studywith a blinded radiological endpoint, 375 patients who had suffered fromactive severe RA for <3 yr were randomized to be treated for 18 monthswith low-dose cyclosporin or parenteral gold. The groups were stratifiedwith regard to corticosteroid use. Primary efficacy variables were numbersof erosions, erosion score and the Larsen-Dale joint damage score. RESULTS:Joint damage progressed at similar rates in both treatment arms. In bothgroups, patients receiving corticosteroids had less X-ray progression.Rheumatoid factor positivity, high swollen joint count, high erythrocytesedimentation rate and pre-existing X-ray abnormalities predictedprogression of joint damage. Although numbers of serious adverse eventswere similar, more gold patients (n = 65) than cyclosporin patients (n =45) withdrew from study medication because of adverse events. CONCLUSION:Cyclosporin was comparable to parenteral gold in retarding progression ofjoint damage and was better tolerated in terms of adherence to therapy. Theopen label design should be kept in mind when assessing this difference.