Treatment of Rheumatoid Arthritis: Challenges to Traditional Paradigms
Authors: Theodore Pincus, Frederick Wolfe
Journal: Annals of Internal Medicine (1991)

Editorials15 November 1991Treatment of Rheumatoid Arthritis: Challenges to Traditional ParadigmsTheodore Pincus, MD, Frederick Wolfe, MDTheodore Pincus, MDSearch for more papers by this author, Frederick Wolfe, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-10-825 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptGold treatment for rheumatoid arthritis has evoked controversy in this journal for at least half a century. In 1942, Cecil and colleagues stated that "in disagreement with Snyder and his co-workers (1) who say that gold treatment should be undertaken only when the arthritis is refractory to every other form of treatment . . . gold salts are most effective in the treatment of early cases (2). . . ." The tradition of controversy in theAnnalsconcerning gold salts was most recently expressed in the report by Epstein and colleagues (3), which suggested that this treatment appeared of no...References1. Snyder R, Traeger C, and Kelley L. Gold therapy in arthritis: observations on 100 cases treated with gold sodium thiosulphate and aurocein. Ann Intern Med. 1939;12:1672-81. LinkGoogle Scholar2. Cecil R, Kammerer W, and DePrume F. Gold salts in the treatment of rheumatoid arthritis: a study of 245 cases. Ann Intern Med. 1942;16:811-27. LinkGoogle Scholar3. Epstein W, Henke C, Yelin E, and Katz P. Effect of parenterally administered gold therapy on the course of adult rheumatoid arthritis. Ann Intern Med. 1991;114:437-44. LinkGoogle Scholar4. Kelley W, Harris E, Ruddy S, and Sledge C eds. Textbook of Rheumatology. 2d ed. Philadelphia: W.B. Saunders; 1985:987. Google Scholar5. Pincus T and Callahan L. 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McCarty D. Arthritis and Allied Conditions: A Textbook of Rheumatology. 11th ed. Philadelphia: Lea & Febiger; 1989:735. Google Scholar17. Wolfe F and Hawley D. Remission in rheumatoid arthritis. J Rheumatol. 1985;12:245-52. MedlineGoogle Scholar18. Wolfe F, Hawley D, and Cathey M. Termination of slow acting antirheumatic therapy in rheumatoid arthritis: a 14-year prospective evaluation of 1017 consecutive starts. J Rheumatol. 1990;17:994-102. MedlineGoogle Scholar19. Thompson P, Kirwan J, and Barnes C. Practical results of treatment with disease-modifying antirheumatoid drugs. Br J Rheumatol. 1985;24:167-75. CrossrefMedlineGoogle Scholar20. Wolfe F, Cathey M, and Hawley D. Improvement in gold treated rheumatoid arthritis patients: a second look at gold effectiveness in the community [Abstract]. Arthritis Rheum. 1991;34:[Suppl]S53. Google Scholar21. Amor B, Herson D, Cherot A, and Delbarre F. Polyarthrites rhumatoides evoluant depuis plus de 10 ans (1966-1978). Ann Med Interne (Paris). 1981;132:168-73. MedlineGoogle Scholar22. Pincus T, Brooks R, and Kim Y. Methotrexate is continued over 5 years significantly longer than other second-line drugs in 536 private practice rheumatoid arthritis patients [Abstract]. Arthritis Rheum. 1990;33(Suppl 9):S40. Google Scholar23. Feinstein A. An additional basic science for clinical medicine: II. The limitations of randomized trials. Ann Intern Med. 1983;99:544-50. LinkGoogle Scholar24. Felson D, Anderson J, and Meenan R. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990;33:1449-61. CrossrefMedlineGoogle Scholar25. Pincus T. Rheumatoid arthritis. Disappointing long-term outcomes despite successful short-term clinical trials. J Clin Epidemiol. 1988;41:1037-41. CrossrefMedlineGoogle Scholar26. Hawley D and Wolfe F. Are the results of controlled clinical trials and observational studies of second line therapy in rheumatoid arthritis valid and generalizable as measures of rheumatoid arthritis outcome? Analysis of 122 studies. J Rheumatol. 1991;18:1008-14. MedlineGoogle Scholar27. Mitchell J, Burkhauser R, and Pincus T. The importance of age, education, and comorbidity in the substantial earnings losses of individuals with symmetric polyarthritis. Arthritis Rheum. 1988;31:348-57. CrossrefMedlineGoogle Scholar28. Brooks R, Callahan L, Harris J, Marcum S, Smith W, and Pincus T. Patient self-report joint count: comparison with assessor-performed traditional joint count [Abstract]. Arthritis Rheum. 1990;33(Suppl 9):S40. Google Scholar29. Pincus T, Callahan L, and Vaughn W. Questionnaire, walking time and button test measures of functional capacity as predictive markers for mortality in rheumatoid arthritis. J Rheumatol. 1987;14:240-51. MedlineGoogle Scholar30. Epstein W, Henke C, and Yelin E. Gold therapy in rheumatoid arthritis [Letter]. Ann Intern Med. 1991;115:155-6. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Theodore Pincus, MD; Frederick Wolfe, MDAffiliations: University of Kansas School of Medicine Wichita, KS 67214 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRheumatoid arthritis databasesA Randomized, Double-Blind, Multicenter, Controlled Clinical Trial of Cyclosporine Plus Chloroquine vs. Cyclosporine Plus Placebo in Early-Onset Rheumatoid ArthritisThe Nutritional Approach to Treating Rheumatoid ArthritisMeasures of activity and damage in rheumatoid arthritis: Depiction of changes and prediction of mortality over five yearsBiobehavioral Pain Research: A Multi-Institute Assessment of Cross-Cutting Issues and Research NeedsWHY SHOULD RHEUMATOLOGISTS COLLECT PATIENT SELF-REPORT QUESTIONNAIRES IN ROUTINE RHEUMATOLOGIC CARE?Therapeutic progress I: Current treatment of rheumatoid arthritisRheumatoid Arthritis: A Medical Emergency?Cognitive-behavioral treatment of rheumatoid arthritis pain maintaining treatment gainsDIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITISWHAT IS THE NATURAL HISTORY OF RHEUMATOID ARTHRITIS?THE NEED FOR AGGRESSIVE THERAPY OF RHEUMATOID ARTHRITISTHE CURIOUS CASE OF INTRAMUSCULAR GOLDComparison and sensitivity to change of self-report scales to assess difficulty, dissatisfaction, and pain in performing activities of daily living over one and five years in rheumatoid arthritisGold Therapy for Rheumatoid ArthritisJohn M. McMahon, MDDisease Modification in Rheumatoid Arthritis with Special Reference to Cyclosporin A 15 November 1991Volume 115, Issue 10 Page: 825-827 Keywords Arthritis Immunology Rheumatoid arthritis Rheumatology Salts ePublished: 1 December 2008 Issue Published: 15 November 1991 PDF downloadLoading ...