IMPACT OF SPIRONOLACTONE ON ACR RESPONSE VARIABLES IN NAIVE RHEUMATOID ARTHRITIS PATIENTS

OBJECTIVES: To determine the ACR response of spironolactone when added to continuing regimen of Disease-Modifying anitrheumatic durgs (DMARDs ) therapy in 28 naive rheumatoid arthritis (RA) patients, who failed to respond adequately on monotherapy or combination of conventional disease modifying agents. METHODS: A distinct study on 28 patients of 24 weeks was designed to gain additional data concern the use of spironolactone (2mg/Kg/OD) in RA patients with active disease despite core standard therapy with DMARDs. American College of Rheumatology (ACR) responses at zero week, 12 week and 24 weeks were calculated statistically. The differences before and after spironolactone treatment were examined by 2-tailed paired student t-test. Results were considered significant at 95% level (p≤0.05) and presented as mean ± SEM. RESULTS: All ACR (20, 50, 70, 90) core set variables were significantly improved after 6 months with spironolactone treatment when compared with baseline in 26 patient. Two patients dropped out the study. 23 patients (88.4%) achieved target response (ACR 20% response), measured as composite index which is based on standard criteria set by American College of Rheumatology and is evaluated as 20% improvement in at least 20% reduction of Tender Joint Count (TJC), Swollen Joint Count (SJC) and in addition to a 20% improvement in at least three of the five activity measures; patient & physician assessment of general health on VAS scale, pain intensity assessment, ESR and HAQ functional questionnaire. Sixteen (61.5%), eleven (42.3%), nine (34.6%) and four (15.3%) patients also achieved ACR 50%, 70%, 90% response respectively after 24 weeks treatment. CONCLUSIONS: The study suggests that when spironolactone added with DMARDs, impacts both clinically and biologically to the patients with RA. The addition of spironolactone to the treatment of patients who respond incompletely to DMARDs alone or in combination may be distinctly valuable in the management of RA.