Objective-To determine the eVect of intramuscular gold and oral hydroxychloroquine(HCQ) on the lipid profile of patients with rheumatoid arthritis (RA). Method-A prospective randomised clinical trial of 12 months' duration was performed in 100 RA patients. Data on clinical and laboratory parameters of disease activity, and fasting serum lipid samples was collected at baseline and at three monthly intervals over one year. Results-The expected second line response was seen with no significant diVerence in eYcacy between the groups at 12 months. The HCQ group had a significant overall improvement in their lipid profile while there was a trend for lipid profiles in the gold group to worsen. Conclusions-HCQ is an eVective second line agent that has beneficial eVects on serum lipids. This should be taken into account when choosing a disease modifying anti-rheumatic drug in patients who suVer from RA and who have significant cardiovascular risk factors.
Background: Optimal use of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis is vital if progression of disease is to be reduced. Methotrexate (MTX) and sulfasalazine (SASP) are widely used inexpensive DMARDs, recently often combined despite no firm evidence of benefit from previous studies. Aim: To establish whether a combination of SASP and MTX is superior to either drug alone in patients with rheumatoid arthritis with a suboptimal response to 6 months of SASP. Methods: A randomised controlled study of step-up DMARD treatment in early rheumatoid arthritis. In phase I, 687 patients received SASP for 6 months. Those with a disease activity score (DAS) >2.4 were offered additional treatment in phase II (SASP alone, MTX alone or a combination of the two). The primary outcome measure was change in DAS. Results: At 6 months, 191 (28%) patients had a DAS ,2.4, 123 (18%) were eligible but did not wish to enter phase II, 130 (19%) stopped SASP because of reversible adverse events and 165 (24%) entered phase II. DAS at 18 months was significantly lower in those who received combination treatment compared with those who received either SASP or MTX: monotherapy arms did not differ. Improvement in European League Against Rheumatism and American College of Rheumatology 20, 50 and 70 scores favoured combination therapy. Conclusions: In this ''true-to-life'' study, an inexpensive combination of DMARDs proved more effective than monotherapy in patients with rheumatoid arthritis with a suboptimal response to SASP. There was no increase in toxicity. These results provide an evidence base for the use of this combination as a component of tight control strategies.
Objective-To ascertain the prevalence of low body mass in a rheumatoid arthritis (RA) population and to explore a possible relation with the acute phase response. Methods-97 patients who fulfilled the American College of Rheumatology (ACR) criteria for RA were recruited. Change in weight from initial presentation was noted. Body mass index (BMI), upper arm fat and muscle areas were recorded together with fat free mass calculated from the waist measurement. Blood samples were taken for erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and serum albumin. Results-13% of the RA group fell into the lowest 5th centile for BMI for the general population. The loss of body mass was greater for lean tissue than fat, with over 50% of the RA group falling into the lowest 10th centile of a reference population for the upper arm muscle area. Female patients who lost greater than 15% of their initial weight had higher health assessment questionnaire (HAQ) results than the rest of the group (p=0.020). In female patients there was a significant correlation between reduced fat free mass and the acute phase response (ESR p=0.016 and CRP p=0.003) Conclusions-There is an increased prevalence of low body mass, greatest for lean tissue, in the RA population. In the female group there was an inverse relation between the acute phase response and fat free mass. Female patients with RA who lose a significant amount of weight are more disabled as assessed by HAQ.
There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.
The number of patients given DMARD treatment within six months of symptom onset increased from 5% (before 1994) to 44% (1994-7). Seventy three per cent of patients waiting more than a year from symptom onset to first clinic appointment already had erosive change, compared with 34% of patients seen within a year. Conclusions-Patients are being referred earlier in their disease, and DMARDs are prescribed sooner in the disease course. There has been a substantial increase in the proportion of patients treated with a DMARD within six months of symptom onset. (Ann Rheum Dis 1999;58:510-513) The "traditional" pyramid of treatment of rheumatoid arthritis (RA) involved treating patients with non-steroidal anti-inflammatory drugs, before progressing to the use of disease modifying anti-rheumatic drugs (DMARDs) in patients with continuing disease activity. In recent years, this strategy has been rejected, and the early use of DMARDs has been advocated.1 There is some evidence from a randomised trial, that patients experiencing a delay in receiving DMARD treatment develop more functional disability and radiological progression compared with those patients receiving immediate DMARD treatment.2 To identify patients who might benefit from such early intervention, "early synovitis" clinics have been set up. In the past, many patients had already developed established radiological damage at presentation, and it has been hoped that the early identification of RA patients might allow treatment to be started before the development of irreversible joint damage. 3There is evidence from the USA that more patients are being treated with DMARDs, 4 but there has been no published evidence to confirm that patients are referred and treated significantly earlier in their disease course. MethodsThe study was conducted at a single teaching hospital that provides secondary care for patients with rheumatic diseases. Recruitment was of 198 sequential patients seen in the rheumatology clinics for their routine review, over a six week period. All patients fulfilled the American College of Rheumatology criteria for the diagnosis of RA.5 A retrospective case sheet review identified the dates of symptom onset, general practitioner (GP) referral, first clinic appointment, and first use of DMARD. Data were collected on age, sex, erythrocyte sedimentation rate, C reactive protein, rheumatoid factor, and the presence/absence of erosions on hand and foot radiographs at the first clinic assessment. Patients were arbitrarily split into four groups according to the date of their first clinic assessment-before 1986, 1987-9, 1990-3, and 1994-7. Between group comparisons were Group 2 (1986Group 2 ( -1989 Group 3 (1990-1993) (n=52) Group 4 (1994Group 4 ( -1997
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.