A controlled trial comparing sulfasalazine, gold sodium thiomalate, and placebo in rheumatoid arthritis


  • H. J. Williams MD,

    Corresponding author
    • University of Utah Medical Center, 50 North Medical Drive, Salt Lake City, UT 84132
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  • J. R. Ward MD,

  • S. L. Dahl PharmD,

  • D. O. Clegg MD,

  • R. F. Willkens MD,

  • T. Oglesby MD,

  • M. H. Weisman MD,

  • S. Schlegel MD,

  • R. M. Michaels MD,

  • M. E. Luggen MD,

  • R. P. Polisson MD,

  • J. Z. Singer MD,

  • S. M. Kantor MD,

  • J. B. Shiroky MD,

  • R. E. Small PharmD,

  • M. I. Gomez MS,

  • J. C. Reading PhD,

  • M. J. Egger PhD


One hundred eighty-six patients with active rheumatoid arthritis were evaluated in a double-blind, randomized study that compared treatment with sulfasalazine (SSZ) (2 gm/day), gold sodium thiomalate (GST) (50 mg/week), and placebo (PBO). The 37—week course of therapy was completed by 109 patients. While marked improvement was seen in all 3 treatment groups, the only statistically significant differences between SSZ or GST and PBO were in a decreased erythrocyte sedimentation rate and increased grip strength in the right hand. GST is known to be superior to PBO, and the response of the GST-treated group was similar to that seen in other trials. The response of the PBO group, however, was much greater than in other placebo groups we have studied. SSZ was similar in efficacy to injectable gold, but was better tolerated. Because of adverse drug reactions (most commonly, rash, stomatitis, and proteinuria), 41% of patients were withdrawn from the GST treatment. Untoward drug effects (most frequently, rash and gastrointestinal distress) caused 16% of patients to be withdrawn from SSZ therapy.