Abstract
> Our thesis is that there is no specific therapy for rheumatoid arthritis. With early diagnosis, simple conservative measures plus salicylates can be so effective that there is little need to utilize more potent pharmacologic therapy with the attendant increase in danger. These words were one man’s opinion of the state of the art of the treatment of rheumatoid arthritis (RA) in 19661. Whether one agreed completely with that opinion or not in 19662, it needs to be acknowledged that the opinion was well argued and informed by a thorough, albeit not systematic, review of the literature of the time. The author found the published evidence on salicylates and personal experiences with bed rest convincing, decried the lack of well-done randomized clinical trials evaluating gold, noted that any longterm benefits of gold were not sustained, and concluded that the lack of sustained effect coupled with the well-known toxicities of gold could not justify its use. This opinion (level II/III evidence) led to a course of action (strength of recommendation C, D). > In the past 3 years, patients have been adequately managed with bed rest, salicylates, and physiotherapy at the Massachusetts Memorial Hospitals and Boston City Hospital. Indeed, gold salt therapy has not been used by any of a large group of Arthritis Clinic Staff Physicians in these clinics, and no patient has been started on this form of treatment. Revisiting the issue of care of RA in 1974, the editors opined that no developments had occurred to alter the conclusions of 19663. Since 1974, the … Address correspondence to Dr. Karsh; E-mail: jkarsh{at}ottawahospital.on.ca
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