TREATMENT OF RHEUMATOID-ARTHRITIS - CHALLENGES TO TRADITIONAL PARADIGMS

A recent report by Epstein and colleagues in the Annals challenged several traditional paradigms concerning rheumatoid arthritis treatment, and concluded that gold is of no value compared with other therapies based on a long-term observational study rather than on a randomized, controlled trial. The challenges to the paradigms in the article appear valid, as clinical rheumatoid arthritis is now recognized to be a progressive disease over long periods, with radiographic damage, functional declines, and increased mortality rates. Patients in the study were stabilized over 5 years, however, suggesting that their disease was managed effectively with gold or other therapies. Possible benefits of gold for rheumatoid arthritis treatment may have been obscured by methodologic problems; these include the timing of data acquisition, use of other second-tine therapies in control patients not receiving gold, and analyses of patients as a group rather than as individuals. Nonetheless, new therapies and combinations of therapies for rheumatoid arthritis appear to be needed.