Can gold therapy be used more safely in rheumatoid arthritis? Adverse drug reactions are more likely in patients with nodular disease, independent of HLA-DR3 status.
OBJECTIVE
. To investigate whether features associated with severe rheumatoid arthritis (RA) are predictive of adverse drug reactions (ADR) to gold salts, independent of HLA-DR3 status.


METHODS
A cohort of patients with RA (n = 41) who developed thrombocytopenia (platelets < 100 10(6)/l) or proteinuria (> 1.0 g/24 h) upon treatment with gold sodium thiomalate was identified from patient records and matched for age, sex, and disease duration with 41 RA controls treated with gold without development of ADR. A second group of 161 random RA patients that had received gold therapy for at least as long without development of an ADR was also compared. All patients were typed for HLA-DRB1, and the presence of rheumatoid factor (RF), antinuclear antibodies (ANA), and nodules before initiation of therapy was recorded. Association of clinical or genetic factors with ADR was investigated using the McNemar test and logistic regression analysis.


RESULTS
Patients with ADR were more likely to have nodular disease than their matched controls (51.3% vs 25.6%; odds ratio, OR = 3.0, p = 0.02) and more likely to be HLA-DR3 positive (41.2% vs 17.6%; OR = 3.0, p = 0.045). No difference between the groups was found for RF or ANA. Nodular disease was associated with development of ADR independently of HLA-DR3, although a combination of both factors significantly increased the likelihood of an ADR.


CONCLUSIONS
Our data suggest that nodular disease may be a predictor of gold-induced ADR independent of HLA-DR3.
From the Staffordshire Rheumatology Centre, University Hospital of North Staffordshire NHS Trust, The Haywood, Burslem, Stoke-on-Trent, Staffordshire, UK.
Preeti
P
Shah
Sian M
SM
Griffith
Michael F
MF
Shadforth
June
J
Fisher
Peter T
PT
Dawes
Kay V
KV
Poulton
Wendy
W
Thomson
William E R
WE
Ollier
Derek L
DL
Mattey
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006052:Gold Sodium Thiomalate / Q000009:adverse effects / Q000627:therapeutic use; D015803:HLA-DR3 Antigen / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000139:chemically induced; D012044:Regression Analysis; D012218:Rheumatoid Nodule; D013921:Thrombocytopenia / Q000139:chemically induced
D018501:Antirheumatic Agents; D015803:HLA-DR3 Antigen; D006052:Gold Sodium Thiomalate