423
Table 1. Effects of chrysotherapy
BRIEF REPORTS
~
Followup study of chrysotherapy In December 1976 we reported on a prospective study on chrysotherapy (Rothermich NO, Philips VK, Bergen W, Thomas MH:Chrysotherapy: a prospective study. Arthritis Rheum 19:1321-1327, 1976). Of the 97 patients who were started on the drug, the final analysis revealed a total of 40 patients who could be considered to have experienced sufficient clinical benefit to warrant continuation of the drug. According to our criteria for benefit, it was believed that these positive results could be attributed directly to the chrysotherapy. A followup study was done to determine the present status of those 40 patients who were originally improved at the end of the prospective study. More than 3 years have passed since the conclusions were drawn in that report. The results of this followup were surprising and disturbing. Only 14 patients were still receiving gold salt injections for their arthritis, whereas 24 had been discontinued and 2 were lost to followup. A breakdown of the 24 who discontinued the gold therapy yields the following: Reasonsfor discontinuance Loss of benefit (relapse) Toxicity Remission Other
Number of patients 14 9 2 2
Three patients experienced both relapse and toxic effects. Of course, the 2 patients who ceased receiving the drug because of remission must be considered on the positive side. However, we were dismayed to learn that there was further attrition of the original 97 “starters” on gold with an additional 20 dropping out because of newly appearing side effects or loss of benefit (relapse). These figures suggest that a majority of the patients with rheumatoid arthritis who initially benefit from gold injections will discontinue this therapy at some point in time because of either loss of benefit or the new appearance of unacceptable side effects. Thus it would appear that only about 15% of all patients in whom chrysotherapy is initiated will still be on such therapy and presumably benefiting from it at the end of 4 to 6 years. The general tenor of these findings is supported by a look at another facet of our gold therapy program which was undertaken because of the unexpected reArthritis and Rheumatism, Vol. 22, No. 4 (April 1979)
M o n t h s ofchrysotherapy
Loss of benefit*
&6
19 19 27 9 13 5 5 2 2
7-12 13-24 25-36 37-48 49-60 61-72 73-84 85-96 97- 120 TOTALS
~
Toxicity. 33 20 7 4 1 0 2
0
I I I
101
70
* Number of patients.
sults described here. Of the first 200 patients started on our open-trial penicillamine therapy, 17 1 had previously been on regular chrysotherapy. Of these, 101 had lost initial benefit and 70 had sustained unacceptable side effects. The emphasis should be directed at those who had been on gold for at least a year or more. From such a perspective, it is seen that a strikingly large number had been receiving benefit from gold for as long as 8 years, and then had relapsed. Similarly, severe side effects can occur and result in discontinuance of therapy even after the patient has been on chrysotherapy for many years. These results are tabulated in Table 1. These figures tend to corroborate the findings and conclusions cited in the first portion of this communication. It would appear that at any point in the course of therapy, whether at 6 months or 6 years, a patient with rheumatoid arthritis on gold may lose therapeutic benefit or develop unacceptable side effects without respect to duration of therapy. These data are disturbing, totally unexpected, and must be confirmed or denied by reports from others. However, from very preliminary studies with penicillamine over the past 6 years, we are beginning to see a similar trend. These data would further support the belief that rheumatoid arthritis is not only a vicious but tenacious disease.
NORMAN0. ROTHERMICH, MD VOL K. PHILIPS,MD WALDEMAR BERGEN,MD MARVINH. THOMAS, MD Columbus Medical Center Columbus, Ohio Address reprint requests to Dr. Norman 0. Rothermich, Columbus Medical Center Research Foundation, 121 1 Dublin Road, Columbus, Ohio 43215. Submitted for publication December 8, 1978; accepted December 8, 1978.
Table 1. Effects of chrysotherapy
BRIEF REPORTS
~
Followup study of chrysotherapy In December 1976 we reported on a prospective study on chrysotherapy (Rothermich NO, Philips VK, Bergen W, Thomas MH:Chrysotherapy: a prospective study. Arthritis Rheum 19:1321-1327, 1976). Of the 97 patients who were started on the drug, the final analysis revealed a total of 40 patients who could be considered to have experienced sufficient clinical benefit to warrant continuation of the drug. According to our criteria for benefit, it was believed that these positive results could be attributed directly to the chrysotherapy. A followup study was done to determine the present status of those 40 patients who were originally improved at the end of the prospective study. More than 3 years have passed since the conclusions were drawn in that report. The results of this followup were surprising and disturbing. Only 14 patients were still receiving gold salt injections for their arthritis, whereas 24 had been discontinued and 2 were lost to followup. A breakdown of the 24 who discontinued the gold therapy yields the following: Reasonsfor discontinuance Loss of benefit (relapse) Toxicity Remission Other
Number of patients 14 9 2 2
Three patients experienced both relapse and toxic effects. Of course, the 2 patients who ceased receiving the drug because of remission must be considered on the positive side. However, we were dismayed to learn that there was further attrition of the original 97 “starters” on gold with an additional 20 dropping out because of newly appearing side effects or loss of benefit (relapse). These figures suggest that a majority of the patients with rheumatoid arthritis who initially benefit from gold injections will discontinue this therapy at some point in time because of either loss of benefit or the new appearance of unacceptable side effects. Thus it would appear that only about 15% of all patients in whom chrysotherapy is initiated will still be on such therapy and presumably benefiting from it at the end of 4 to 6 years. The general tenor of these findings is supported by a look at another facet of our gold therapy program which was undertaken because of the unexpected reArthritis and Rheumatism, Vol. 22, No. 4 (April 1979)
M o n t h s ofchrysotherapy
Loss of benefit*
&6
19 19 27 9 13 5 5 2 2
7-12 13-24 25-36 37-48 49-60 61-72 73-84 85-96 97- 120 TOTALS
~
Toxicity. 33 20 7 4 1 0 2
0
I I I
101
70
* Number of patients.
sults described here. Of the first 200 patients started on our open-trial penicillamine therapy, 17 1 had previously been on regular chrysotherapy. Of these, 101 had lost initial benefit and 70 had sustained unacceptable side effects. The emphasis should be directed at those who had been on gold for at least a year or more. From such a perspective, it is seen that a strikingly large number had been receiving benefit from gold for as long as 8 years, and then had relapsed. Similarly, severe side effects can occur and result in discontinuance of therapy even after the patient has been on chrysotherapy for many years. These results are tabulated in Table 1. These figures tend to corroborate the findings and conclusions cited in the first portion of this communication. It would appear that at any point in the course of therapy, whether at 6 months or 6 years, a patient with rheumatoid arthritis on gold may lose therapeutic benefit or develop unacceptable side effects without respect to duration of therapy. These data are disturbing, totally unexpected, and must be confirmed or denied by reports from others. However, from very preliminary studies with penicillamine over the past 6 years, we are beginning to see a similar trend. These data would further support the belief that rheumatoid arthritis is not only a vicious but tenacious disease.
NORMAN0. ROTHERMICH, MD VOL K. PHILIPS,MD WALDEMAR BERGEN,MD MARVINH. THOMAS, MD Columbus Medical Center Columbus, Ohio Address reprint requests to Dr. Norman 0. Rothermich, Columbus Medical Center Research Foundation, 121 1 Dublin Road, Columbus, Ohio 43215. Submitted for publication December 8, 1978; accepted December 8, 1978.
