On the course of seropositive rheumatoid arthritis during and after long-term gold therapy

The purpose of the present study was to get an estimate on the course of seropositive RA in 93 patients, who had been in chrysotherapy for at least 3 years up to 13 years. The study was observational with assessment once a year by the same physician. After one year the median number of swollen joints had decreased from six to two (p = 0.0001), and the median number of tender joints from five to two (p = 0.0001). This improvement was maintained throughout the period. A decrease in median erythrocyte sedimentation rate from 34 mm/h to 15 mm/h remained significant for 10 years, although the ESR gradually increased throughout the period. An increase in median hemoglobin from 7.8 mmol/l to 8.5 mmol/l lasted for 7 years. Contrastingly, the number of joints with limited motion increased from a median score of 4 to a median score of 20 (p = 0.0001). Radiographical changes progressed from a median score of 18 to a median score of 84 (p = 0.0001). Significant correlations were found between the ESR, joint tenderness score and limitation of motion score at the year 1, and later progression of limitation of motion score, but too weak to be of predictive importance. In conclusion early symptomatic improvement of rheumatoid arthritis during gold treatment can be stable during several years, but progression in the number of joints with limited motion and radiographical changes continues.