Slow onset anti-rheumatic drugs in rheumatoid arthritis: could the presence of antinuclear antibody influence the therapeutic results?

The therapeutic value of sodium aurothiomalate, D-penicillamine and levamisole was evaluated in three comparable groups of 20 rheumatoid arthritis (RA) patients. There was no intergroup difference after a 3-month follow-up and all were significantly improved (p less than 0.001). To verify if, in these patients, the presence of antinuclear antibodies (ANA) had influenced the therapeutic results, each group was retrospectively subdivided according to the ANA status. To start with, all the sub-groups were statistically comparable on the basis of measures of disease activity. The D-penicillamine group could not be analyzed. In the gold treated group, the ANA negative patients were more improved than the ANA positive (p = 0.03), and very significantly more than the levamisole-treated ANA-negative patients (p = 0.005). The ANA negative patients taking levamisole had less pain relief (p = 0.01) and showed a tendency for less overall improvement (p = 0.15) than the ANA positive patients. This preliminary study supports the idea that systematic ANA testing in RA may be of practical and theoretical value.