Results of a one-year trial of tolmetin in patients with rheumatoid arthritis.

The safety and effectiveness of tolmetin was assessed in ten patients with active rheumatoid arthritis for 12 months. All patients met the requirements of the American Rheumatism Association's diagnostic criteria for definite rheumatoid arthritis. None of the patients had received gold, antimalarials, or glucocorticoids. All had been stabilized, more or less, with aspirin. Monthly measurements were made of grip strength, duration of morning stiffness, time to the onset of fatigue, Westergren sedimentation rates, the number of swollen joints, number of hot joints, the time to walk 50 feet, and the circumference of proximal interphalangeal (PIP) joints (measured in millimeters with a plastic-loop arthrocircameter). The initial dosage of tolmetin in all patients was 600 mg a day, given orally in three divided doses. Upon completion of the study, the average daily oral dosage was 1400 mg tolmetin. No other antiinflammatory drugs were allowed. The results indicate that tolmetin affords symptomatic relief of rheumatoid arthritis; its use results in global improvement in 80 per cent of the patients, and a net improvement in one or more of the parameters used to assess disease activity in 100 per cent of the patients; it seems to be sufficiently safe to administer to patients over a long period of time; there was no evidence of severe toxicity of any kind; gastrointestinal side effects were uncommon, and epigastric distress, in particular, was not observed.