慢性関節リウマチの基礎的ならびに臨床的研究 第二編 血中金濃度を指標とした治療に関する臨床的研究

The therapeutic use of gold compounds for rheumatoid artritis has endured for more than three decades and its effectiveness has been well established. However, we have never seen any report directly compared goldthioglucose (GTG) with gold sodium thiomalate (GTM) in regard to their therapeutic effects. Therefore in the present study, some estimations such as gold levels in blood and urine, ESR, CRP, titre of rheumatoid factor, urinary 17-KGS excretion, body weight and clinical symptoms including side effects, etc. were determined in 39 patients with rheumatoid arthritis who were receiving chrysotherapy (23 cases treated with GTG and 16 with GTM). All the 39 patients studied were suffering from definite or classical rheumatoid arthritis according to the ARA diagnostic criteria with duration of 1.2 years or more. Each gold salt was given intramuscularly in doses beginning with 10mg×2/W for two weeks, 25mg×2/W for two weeks and then 50mg once a week depending upon clinical response. The plasma gold content and the urinary gold excretion were assayed at the last days when patients had received a total dose of 40mg, 140mg, 540mg………of gold salts. Gold levels in blood and urine were determined by atomic absorption spectrophotometry. Comparing GTG with GTM in regard to anti-rheumatic effects, the anthor obtained the results as follows; 1) There was statistically significant correlation between plasma gold levels and gold compounds (GTG or GTM) administered. 2) Good therapeutic response initially appeared in rheumatoid patients, when the gold concentrations had risen approximately to 250～300ug/dl of plasma level. 3) The efficacy rate of the treatment proved to be 73.9% in the cases given GTG and 68.8% given GTM. No statistically significant difference was noted between GTG and GTM. 4) There appeared a transient elevation of urinary 17-KGS excretion in the course of chrysotherapy. 5) The increasing rate of body weight was significantly higher in GTG-treated patients than in GTM-treated patients during gold therapy. 6) The incidence of side effects, which noticed in various gold levels of blood and urine, was observed in 52.2% of those who treated with GTG and in 43.8% of GTM. There was no statistically significant difference between two.