Late results of gold treatment in rheumatoid arthritis.

Gold treatment has always been a matter of debate; this is partly owing to the difficulties in judging the results, and partly owing to toxic secondary effects. The tendency of rheumatoid arthritis to spontaneous remissions and progressions has not been sufficiently taken into account. In addition, the various case histories are not comparable, since they fail to give elementary information concerning the age-distribution, sex, duration of history, etc. Several authors define the terms "healed, improved, unchanged, and deteriorated " more or less subjectively. Steinbrocker and Blazer (1946) proposed giving points according to the clinical findings to obtain a more objective conception of the effect of this therapy. Generally, most of the published material lacks control groups for the comparison of gold treatment on the one hand, and, e.g., physical treatment only, on the other. Most authors give only the primary results of treatment, the number of improved cases varying between 50 and 95 per cent. Such a high percentage of improved cases as 95 per cent. is, apparently, due to the inclusion of the mild cases with uncertain diagnosis. As to the late results of this therapy, the figures are much less encouraging. Thus, Ragan and Tyson (1946) showed that in a series of 142 patients, 75 per cent. relapsed in the course of 3 years. Kling, Vento, and Sashin (1949) found that 17 per cent. relapsed in a series of 455 patients after one year, 57 per cent. after 5 years, and 75 per cent. after 10 years. As stated above, most of the reports lack control groups. Nevertheless, some investigations deal with such groups. Ellman, Lawrence, and Thorold (1940) and Fraser (1945) found that after one year of observation the cases treated with gold showed better results than those not so treated. Secher (1946), after a control examination held 5 to 13 years later on 231 cases of rheumatoid arthritis treated with sanocrysin, showed that 60 to 70 per cent. had improved. Snorrason (1950), partly on the same number of cases, demonstrated an improvement in 80 per cent. after 4 years' follow-up. In a control group given only physical therapy, he obtained only a 50 per cent. improvement. Short, Beckman, and Bauer (1946) declared gold treatment to be of no definite value, but their experience of it was limited to 47 patients. Waine, Baker, and Mettier (1947) published a control examination of 120 patients, 62 of whom had been treated physically and 58 with gold, with doses exceeding 0 5 g. per patient. The cases were followed up for an average of 29 years and the percentage of those free from symptoms, or markedly