Some characteristics of RA patients with and without side effects due to gold treatment

A prospective analysis of risk factors for the discontinuation of second-line antirheumatic drugs

Clinical and laboratory factors influencing the discontinuation of second-line antirheumatic drugs were prospectively studied using survival analysis in a consecutive series of 245 patients with recently diagnosed rheumatoid arthritis. A statistically significant influence of age, sex, serum IgA and HLA-DR3 on the discontinuation rate of chrysotherapy because of toxicity was observed. The discontinuation of sulfasalazine was increased by advanced age and high rank order of prescription. With respect to efficacy, high initial disease activity appeared to predispose to treatment termination of hydroxychloroquine, sulfasalazine and penicillamine. Furthermore, an influence of the rank order of prescription on discontinuation of sulfasalazine therapy because of lack of efficacy was found. Of interest is that discontinuation of hydroxychloroquine therapy because of lack of efficacy occurred less frequently in HLA-DR3-positive than in HLA-DR3-negative patients. Although these prognostic factors are of secondary importance in clinical practice, they may be of significance in the interpretation and comparison of clinical trials.

Risk factors that may influence development of side effects of gold sodium thiomalate

Two hundred and seventy-seven patients who had received gold sodium thiomalate (GST), were included in a retrospective study to identify those factors that might have influenced the development of side effects. Fifty-one per cent of patients were excluded due to side effects, especially skin rash, which affected 59% of those excluded. The duration of disease when GST therapy was commenced, female sex, and a history of smoking were identified as factors influencing the development of certain side effects. There was a high incidence of skin rash in smokers. Of 99 smokers, 40% developed dermatitis, whereas in 109 non-smokers, only 17% developed a rash (p less than 0.001). Other factors such as age, weight, and concurrent drug therapy, biochemical, haematological and immunological data, do not predict development of toxicity to GST.

Association of different HLA antigens with various toxic effects of gold salts in rheumatoid arthritis

An association of gold induced proteinuria with HLA-D(R)3 has been reported. To investigate other possible relationships between gold toxicity and HLA antigens we studied 85 patients with rheumatoid arthritis (RA) divided into four subgroups: patients with gold induced interstitial pneumonitis, mucocutaneous lesions, proteinuria, and patients without gold toxicity. The HLA frequencies in patient groups and 283 healthy controls were compared in different pairwise combinations. Gold induced pneumonitis was associated with HLA-B40 and Dw1. An association between gold induced proteinuria and HLA-Dw3 was also seen. The increased prevalence of Dw4 in RA was observed only in the control patient group without gold induced side effects. The frequencies of HLA-B7 and Dw2 were decreased in all patient groups compared with the control population. These results further support the view of the heterogeneity of RA as manifested by the unique HLA associations with resistance and susceptibility to gold induced side effects characterising different subgroups.

Second course gold therapy in the treatment of rheumatoid arthritis

Twenty-three rheumatoid arthritis patients who had previously received gold therapy were selected for second course gold. Eleven patients had developed complete remission during the first course of gold therapy. Four of these had a complete response to second course gold. Of the 10 nonresponders and 2 partial responders to first course gold, none responded to second course gold. We conclude that individuals in whom first course gold is unsuccessful respond poorly to repeated gold treatments. In addition, only 36% of the patients who initially had a complete response sustained complete remission with second course gold.

Neurologic complications induced by gold treatment

Two patients developed a Guillain-Barre-like syndrome and a third suffered neuropathy and myokymia during therapy with sodium aurothiomalate. The cumulative dose at the time of development of neuropathy was different in all 3 cases. Evidence for gold toxicity was suggested by clinical, electromyographic, and histologic findings, as well as the disappearance of symptoms and signs on cessation of gold injections.