Gold compounds have been used in several conditions affecting man since the 18th century (tuberculosis, lupus vulgaris, bacterial endocarditis, etc.) however, in the past decade the use of injectable gold for rheumatoid arthritis has markedly declined, and its clinical usefulness has been doubted.
To estimate the short-term benefit and risk of side-effects of injectable gold for rheumatoid arthritis.
We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to July 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles.
Randomized clinical trials (RCT) comparing injectable gold against placebo in patients with rheumatoid arthritis were included.
Data collection and analysis
Methodological quality of the RCTs was assessed by two reviewers (MS, BS) (kappa=1.0). Rheumatoid arthritis outcome measures were extracted by two reviewers from the publications for the 6 month endpoint. Sufficient data was obtained to conduct a pooled analysis of the number of swollen joints, physician global assessment, patient global assessment and erythrocyte sedimentation rate (ESR). Results were analyzed as standardized weighted mean differences for swollen joints and global assessments and weighted mean differences for ESR. Toxicity was evaluated with pooled odds ratios for withdrawals. Heterogeneity was estimated using a chi-square test. Fixed effects models were used throughout.
Four trials and 415 patients were included. A statistically significant benefit was observed for injectable gold when compared to placebo. The standardized weighted difference (effect size) between gold and placebo for the number of swollen joints was -0.5, translating into a percentage change of 30% in favour of gold adjusted for placebo. Statistically significant differences were also observed for ESR and patient and physician assessments. Twenty two percent of the treated patients withdrew from toxicity compared to 4% of controls (OR=3.9 - 95%Cl: 2.1 - 7.2).
Although its use can be limited by the incidence of serious toxicity, injectable gold has an important clinically and statistically significant benefit in the short term treatment of patients with rheumatoid arthritis.
搜尋Cochrane Musculoskeletal Group trials register, 及MEDLINE到1997年7月前資料。核對臨床試驗裡的的參考文獻，並諮詢本領域之專家及搜尋發表及未發表文獻。
4個研究﹝415例病患﹞包含於分析中。金製劑注射比安慰劑有統計上顯著差異。金製劑注射比安慰劑在腫脹的關節數方面，標準化加權平均差異(effect size)為負0.5，即約30%差異。在病人總體評估及紅血球沈降速率亦有統計上顯著差異。金製劑注射組有22%因副作用退出，而安慰劑組有4% (OR = 3.9; 95% CI: 2.1 – 7.2)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。