Intervention Review

Injectable gold for rheumatoid arthritis

  1. Patricia Clark2,
  2. Peter Tugwell3,
  3. Kathryn J Bennett4,
  4. Claire Bombardier5,
  5. Beverley Shea6,
  6. George A Wells7,
  7. Maria E Suarez-Almazor1,*

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 20 OCT 1997

Assessed as up-to-date: 28 AUG 1997

DOI: 10.1002/14651858.CD000520


How to Cite

Clark P, Tugwell P, Bennett KJ, Bombardier C, Shea B, Wells GA, Suarez-Almazor ME. Injectable gold for rheumatoid arthritis. Cochrane Database of Systematic Reviews 1997, Issue 4. Art. No.: CD000520. DOI: 10.1002/14651858.CD000520.

Author Information

  1. 1

    The University of Texas, M.D. Anderson Cancer Center, General Internal Medicine, Ambulatory Treatment and Emergency Care, Houston, Texas, USA

  2. 2

    Hospital General de Mexico, Unidad de Epidemiologia Clinica, Mexico City, Mexico

  3. 3

    Ottawa Hospital, Centre for Global Health, Institute of Population Health, Department of Medicine, Ottawa, Ontario, Canada

  4. 4

    McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada

  5. 5

    Institute for Work & Health, Toronto, Ontario, Canada

  6. 6

    University of Ottawa, Institute of Population Health, Ottawa, Ontario, Canada

  7. 7

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

*Maria E Suarez-Almazor, General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1465, Houston, Texas, 77030, USA. msalmazor@mdanderson.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 OCT 1997

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

To estimate the short-term benefit and risk of side-effects of injectable gold for rheumatoid arthritis.

Search methods

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.

Selection criteria

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.

Main results

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).

Authors' conclusions

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Injectable gold for treating rheumatoid arthritis

Injectable gold has been used to treat several conditions since the 18th century. This review included four trials and 415 patients. Patients receiving gold injections had 30% fewer swollen joints compared to patients receiving placebo. Improvements were also found for blood work and patient and physician assessments in those patients receiving gold injections. 22% percent of the treated patients withdrew from toxicity compared to 4% of patients taking placebo.  

Although its use can be limited by the incidence of serious harms, injectable gold has an important clinically and statistically significant benefit in the short term treatment of patients with rheumatoid arthritis.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

金製劑注射治療類風濕性關節炎

金製劑在18世紀,曾用於治療結核病、狼瘡、細菌心內膜炎等,而金製劑注射用於治療類風濕性關節炎明顯減少,且療效有人存疑。

目標

評估金製劑注射治療類風濕性關節炎的短期效益與風險。

搜尋策略

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。

選擇標準

含金製劑注射及安慰劑用於治療類風濕性關節炎之隨機對照試驗

資料收集與分析

2個評論者評估試驗品質跟擷取6個月結果指 標數據。評估包括腫脹的關節數,醫師的總體評估,病人的總體評估,及紅血球沈降速率。並以標準化加權平均差異做腫脹的關節數及總體評估,以加權平均差異評估紅血球沈降速率。毒性評估則以退出治療之勝算比為指標。異質性由卡方檢定評估。使用固定效果模式分析。

主要結論

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)。

作者結論

金製劑注射雖有潛在嚴重副作用風險,但在短期治療類風濕性關節炎時,有臨床及統計上顯著差異。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結