A trial was designed to assess the effects of intramuscular
sodium aurothiomalate or intravenous
cyclophosphamide, or both, in combination with intravenous 'pulse'
methylprednisolone in severe intractable
rheumatoid arthritis. Thirteen patients with severe, active
rheumatoid arthritis, unresponsive to conventional therapeutic regimens showed improvement in
synovitis after receiving a single intravenous bolus of
methylprednisolone (15 mg/kg). Early morning stiffness and Ritchie articular index remained improved over pretreatment values after 12 weeks. There was an early fall in the erythrocyte sedimentation rate, which returned to baseline levels by four weeks. A concomitant intravenous pulse of
cyclophosphamide (1 g/m2 body surface area) given to eight patients did not confer any additional benefit. Six patients received
sodium aurothiomalate, up to 100 mg intramuscularly a week, and in these patients the early improvement in
synovitis induced by
methylprednisolone was maintained. Thus between 12 and 24 weeks the Ritchie articular index, visual analogue
pain score, erythrocyte sedimentation rate, haemoglobin, and immunoglobin G were significantly better in the patients treated with
gold and
methylprednisolone than in those treated with
methylprednisolone alone, irrespective of whether they had received
cyclophosphamide.
Methylprednisolone pulse
therapy given at the start of
gold treatment results in early improvement in
synovitis, maintained until the usual delay in achieving a
therapeutic effect from
gold has elapsed.