Gold therapy in the management of juvenile rheumatoid arthritis

Brewer, Earl J.; Giannini, Edward H.; Barkley, E. M.

doi:10.1002/art.1780230403

Cited by 63 publications

(17 citation statements)

References 26 publications

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“…Intramuscular administration of gold is often used to replace treatment with steroids and NSAIDs, and its use as a first-choice remission-inducing drug is increasing. The adverse reactions to intramuscular gold administration in children with JRA are similar to those reported in adults, i.e., rash, headache, anemia, nitritoid reaction, as well as the nephrotic syndrome (1,2).…”

supporting

confidence: 59%

The efficacy and safety of auranofin in the treatment of juvenile rheumatoid arthritis

Marcolongo

Mathieu

Pala

et al. 1988

Arthritis & Rheumatism

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The safety and efficacy of auranofin in the long‐term treatment of children with juvenile rheumatoid arthritis was investigated in an open study of 14 patients. Twelve patients completed at least 12 months of treatment, and 7 patients completed 36 months of treatment. Classic parameters of disease activity showed improvement over baseline values after 6 months of treatment, and laboratory indices remained stable or improved throughout the study. Auranofin was well tolerated; the frequency of adverse effects was lower in these patients than has been previously reported in either adults or children whose arthritis has been treated with injectable gold.

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supporting

confidence: 59%

The efficacy and safety of auranofin in the treatment of juvenile rheumatoid arthritis

Marcolongo

Mathieu

Pala

et al. 1988

Arthritis & Rheumatism

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“…Several second-line drugs have been used in SO-JRA with little success in controlling the disease activity [8][9][10]. Studies have shown that gold, penicillamine and azathiprine are associated with toxic effects and loss of efficacy when used as a longterm therapeutic modality [16][17][18]. MTX has been proven to be an effective agent for the treatment of otherwise resistant cases of JRA with infrequent short-term toxicity [12,15,19] and better tolerance than in adults [20,21].…”

Section: Discussionmentioning

confidence: 99%

Methotrexate therapy in systemic-onset juvenile rheumatoid arthritis in Saudi Arabia: A retrospective analysis

et al. 1998

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Eighteen patients (nine girls, nine boys) with systemic onset juvenile rheumatoid arthritis (SO-JRA) treated with methotrexate (MTX) for a mean period of 18 months (range 6-41 months) were analysed to evaluate the safety and efficacy of MTX in this disease subtype. The MTX dose ranged from 2.5 to 15 mg/week with a mean cumulative dose of 684.9 mg/patient at the last follow-up visit. Systemic features were severe in 10 patients before MTX was started. None of these patients showed systemic features at the last follow-up visit. Sixteen patients (89%) showed improvement in both the active joint count (from a mean of 12.0 to 1.3 joints/patient) and function class (from a mean of 3.0 to 1.3) while receiving MTX. Eleven patients (61%) showed a significant decrease in the erythrocyte sedimentation rate (>50% of the initial value), an improvement in anaemia (haemoglobin >2 g) and reduced thrombocytosis (platelets 2 x 10[5]). Of the patients receiving corticosteroids, three patients (20%) were able to discontinue prednisone and the dose was reduced to less than 50% of the initial dose in seven patients (47%). At these doses of MTX, no gastrointestinal, hepatic or haematological toxicity was encountered and none of the patients withdrew because of toxicity or lack of efficacy. This report suggests that MTX is an effective and safe treatment in controlling systemic and articular features in this subtype of JRA.

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“…Brewer et a1 reported the results of a retrospective review of 63 patients with JRA treated with injectable gold during a 20-year period at Texas Children's Hospital (20). Fifty-one of 63 patients received the drug for at least 6 months and served as the efficacy subset.…”

Section: Discussionmentioning

confidence: 99%

Auranofin in the treatment of juvenile rheumatoid arthritis

Giannini

Brewer

Кузьмина

et al. 1990

Arthritis & Rheumatism

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A 6-month double-blind, parallel, randomized, placebo-controlled multicenter trial of auranofin (0.15-0.20 mg/kg/day) was conducted in 231 children with juvenile rheumatoid arthritis (JRA) in the United States and in the Union of Soviet Socialist Republics. Approximately 80% of the children had polyarticular disease. The auranofin-treated patients showed greater mean decreases from baseline in 11 of the 12 articular disease indices measured than did the placebo-treated subjects after 3 months of therapy, and in 9 of the 12 indices after 6 months. However, the actual intergroup mean differences were relatively small and were not statistically significant. According to the physician's global assessment, 69% of the auranofin-treated patients and 61 % of the placebo-treated patients demonstrated clinically significant improvement from baseline after 6 months (P = 0.24). Children whose disease onset occurred less than 2 years prior to entry improved more than did those who had arthritis for a longer period. In addition, those with polyarticular involvement at baseline improved more than did patients with mild disease. However, these relationships were observed in both the auranofin-and placebo-treated groups, and again, there were no significant intergroup differences. Diarrhea was the most common adverse effect of auranofin. We conclude that the clinical eflicacy of auranofin is modestly higher than that of placebo in the treatment of JRA, as evidenced by the consistent trends observed in the data. However, the magnitude of the individual intergroup differences is not statistically significant. Auranofin appears to be very safe in children with JRA. Articular disease activity is adequately controlled by nonsteroidal antiinflammatory drugs (NSAIDs) in approximately 5040% of children with juvenile rheumatoid arthritis (JRA). The rest of these children frequently experience more severe, progressive disease, and are considered to be candidates for slow-acting antirheumatic drugs (SAARDs). Goldcontaining compounds, D-penicillamine, and hydroxychloroquine represent thc 3 most frequently prescribed agents in this class of drugs. Recently, chrysotherapy has taken on added importance following the reports by Brewer et al(1) and Giannini et a1 (2) that neither D-penicillamine nor hydroxychloroquine, in the presence of NSAIDs, offers significant therdpeutic advantage over placebo plus NSAIDs in patients with JRA.Clinical evaluation of the oral gold preparation auranofin began in 1976 and to date, over 4,000 patients with adult rheumatoid arthritis (RA) have been entered into trials of its safety and efficacy (3). Studies in these patients have shown auranofin to possess a definite degree of efficacy over placebo, with a low incidence of severe toxicity (4-6). We have previously 468GIANNINI ET AL Informed consent. Prior to randomization, a parent or legal guardian of the child was asked to give informed consent. Patients who were 7 years or older were also asked to sign a modified consent document.Monitoring of efficacy and ad...

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Gold therapy in the management of juvenile rheumatoid arthritis

Cited by 63 publications

References 26 publications

The efficacy and safety of auranofin in the treatment of juvenile rheumatoid arthritis

The efficacy and safety of auranofin in the treatment of juvenile rheumatoid arthritis

Methotrexate therapy in systemic-onset juvenile rheumatoid arthritis in Saudi Arabia: A retrospective analysis

Auranofin in the treatment of juvenile rheumatoid arthritis

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