Rheumatoid arthritis, gold therapy, contact allergy and blood cytokines.
OBJECTIVE
To study the clinical and biochemical effects of a low starting dose for gold therapy in rheumatoid arthritis patients with a contact allergy to gold.


METHODS
Serum cytokines were assayed before and 24 h after the first injection of gold sodium thiomalate (GSTM).


RESULTS
Contact allergy to gold was found in 4 of 19 patients. Compared to gold-negative patients (starting dose: 10 mg GSTM), there was a larger increase in serum TNFalpha (p < 0.05), sTNF-R1 (NS), and IL-1 ra (p < 0.05) in gold-allergic patients.


CONCLUSIONS
Cytokines are released in blood by GSTM in RA patients with gold allergy. To minimize the risk of acute adverse reactions the starting dose of GSTM should be lowered to 5 mg. Alternatively, patients should be patch-tested before gold therapy; in test-positive cases, 5 mg is recommended as the first dose.
Svensson
Ake
A
Department of Dermatology, Malmö University Hospital, Sweden. ake.svensson@skane.se
Möller
Halvor
H
Björkner
Bert
B
Bruze
Magnus
M
Leden
Ido
I
Theander
Jan
J
Ohlsson
Kjell
K
Linder
Carina
C
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D001831:Body Temperature; D016207:Cytokines / Q000097:blood*; D017449:Dermatitis, Allergic Contact / Q000209:etiology* / Q000276:immunology; D005260:Female; D006052:Gold Sodium Thiomalate / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged
D018501:Antirheumatic Agents; D016207:Cytokines; D006052:Gold Sodium Thiomalate