Sequential gold and penicillamine therapy in rheumatoid arthritis

Human Leucocyte Antigen Phenotypes and Gold-Induced Remissions in Patients With Rheumatoid Arthritis

“…The high male percentage observed in the remission group is in concordance with other studies [5,14]. However, in the literature there is no support for the suggestion of disparity between the sexes in response to treatment with gold or other DMARDs [16, 31,32]. Therefore, instead of a differ ence in response to gold the high male percentage possibly reflects the conclusions of several studies that men with RA fare better than women with RA [33,34].…”

Nephrotoxicity of gold salts, D-penicillamine, and allopurinol

“…The risk of proteinuria is increased at higher doses [102,[133][134][135], in patients with HLA B8 and/or DRw3 antigens [70], and in patients with previous gold toxicity [136,137). However, other have not confirmed the relationship to the drug dosage [138], duration of therapy [138], HLA antigens [72].…”

“…To predict D-penicillamine side effects, the association between side effects and various factors, such as HLA antigens [70,72,130,132,165,166], autoantibodies [167,168], and previous gold toxicity [103,140,169,170] has been studied. Wooley et al [70] investigated the possible relation between HLA antigens and toxicity of D-penicillamine and sodium aurothiomalate in rheumatoid arthritis patients.…”

“…Despite their dissimilar chemie al structures, the thiol compounds, sodium aurothiomalate and D-penicillamine, have remarkably similar clinical effects, and there is a marked similarity in incidence and type of adverse effects [140,169]. The association between prior gold nephropathy and D-penicillamine was discussed by several investigators.…”

Gold Nephropathy

“…Despite the occa sional negative report [54] there is strong evidence that the incidence of proteinuria during penicillamine treat ment is significantly increased (17 83%) in patients who developed proteinuria during previous gold treatment as compared with patients who tolerated previous chryso therapy without proteinuria(3-21%) [38,48,[55][56][57][58][59]. How ever other adverse reactions to gold do not appear to increase the risk of proteinuria during subsequent peni cillamine treatment [58,59], There should be compelling clinical reasons, usually a good response to gold treat ment when other agents have been ineffective or caused adverse reactions, behind the decision to continue chry sotherapy despite haematuria or proteinuria or to retreat with gold a patient with previous gold (or penicillamine) nephropathy. Clearly these are exceptional circum stances and the GFR and urinary protein excretion should be monitored carefully.…”