Treatment of aggressive rheumatoid arthritis in adults with combination of gold thiomalate, methotrexate and chloroquine with intermittent parenteral depot-methylprednisolone in tapering dose in early stage while avoiding use of non-steroidal anti-inflammatory drugs

34 adult patients with aggressive rheumatoid arthritis (RA) were selected with an intent-to-treat with a combination of gold thiomalate (GTM), methotrexate (Mtx) and chloroquine (CQ) with intramuscular depot-methylprednisolone (IM-MP) in a tapering weekly dose. Non-steroidal anti-inflammatory drugs (NSAIDs) were not given to these patients. Paracetamol or dextropropoxiphene were given only in those where pain was not controlled with IM-MP. 9 (26.5%) patients dropped out after the first visit due to non-medical (mostly domestic) reasons. All of them were traced and found alive taking some form of irregular treatment Of the remaining 25 patients who completed 1 year follow-up, 3 (12%) could not continue the same regimen due to skin rash requiring change of medicine. Another 5 (20%) patients developed mouth ulceration which was minor and which subsided without discontinuation of the medicines. No life-threatening adverse effects were seen in any patient. Of the 22 patients completing the trial 13 (59%) responded with improvement in inflammatory synovitis, 3 (13.5%) of whom achieved complete remission. 9 (41%) patients did not show significant improvement but still continued the follow up.