The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36-week randomized trial comparing methotrexate and auranofin

Authors

  • Michael E. Weinblatt MD,

    Corresponding author
    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
    • Department of Rheumatology and Immunology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215
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  • Richard Polisson MD,

    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
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  • Steven D. Blotner MS,

    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
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  • J. Leland Sosman MD,

    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
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  • Piran Aliabadi MD,

    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
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  • Nancy Baker MD,

    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
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  • Barbara N. Weissman MD

    1. Departments of Rheumatology and Immunology and Radiology, Brigham and Women's Hospital, and the Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Clinical Statistics, Medical Research Division, American Cyanamid, Pearl River, New York.
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Abstract

Objective. To determine the effects of drug therapy (methotrexate [MTX] versus auranofin [AUR]) on radiographic progression in patients with active rheumatoid arthritis (RA).

Methods. We conducted a 9-month randomized, multicenter, double-blind trial comparing MTX and AUR. Standardized radiographs of the hands and wrists were obtained at baseline and at completion of the study. Four experienced bone radiologists graded the radiographs for erosions, joint space narrowing, erosion healing, and reparative bone formation.

Results. Two hundred eighty-one patients were enrolled in the study. Radiographs were available on 167 of the 183 who completed the trial. After 9 months of therapy, there was a significantly greater worsening of the erosion score in the AUR group (mean ± SEM change of 1.67 ± 0.4) compared with the change in the MTX group (0.60 ± 0.3) (P = 0.040). There was also a significantly greater worsening of the joint space narrowing score in the AUR group compared with the MTX group (1.36 ± 0.3 versus 0.42 ± 0.2) (P = 0.007). There was no difference demonstrated between groups in healing of erosions or in reparative bone formation.

Conclusion. The rate of radiographic progression in patients with RA, as measured by erosion score and joint space narrowing score, was demonstrated to be lower in those treated with MTX, as compared with AUR, over a 36-week period.

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