Læknablaðið : fylgirit - 01.05.1978, Page 50

Anna-Liisa Mákelá and Jarkko Haapasaari
Department of Paediatrics, Turku University
Hospital, Turku, Finland
GOLD THERAPY AND ITS SIDE
EFFECTS IN CHILDREN WITH
JUVENILE RHEUMATOID
ARTHRITIS
The toxicity of chrysotherapy and the role of
serum gold concentrations in the adjustment of
gold therapy has been widely discussed in recent
years. In 1973 Lorber and coworkers pointed
out the importance of monitoring the serum gold
values. According to them, the beneficial
response to chrysotherapy is more likely to be
sustained if the serum gold concentration is
maintained at or abcrve 300 ug per cent, corre-
sponding to 15 umol/1. (1) In Figure 1, by
Lorber and coworkers the serum gold levels in
patients receiving conventional chrysotherapy
with monthly gold injections are compared with
those achieved by adjusted regimen with weekly
gold injections. A sharp increase in serum
gold levels is seen within 2 hours after gold
injections. Thereafter, there is a progressive
fall during the ensuing week or weeks. With

0-212 3 4 5 6 7
h Days afler
injection
Adjusled
therapy
Conventional
_ therapy
Fig. 1 Serum gold levels in patients receiving
conventional chrysotherapy with monthly
gold injections are compared with those
achieved by adjusted regimen with weekly
gold injections.
(Lorber et al.: Ann rheum Dis 32:133, 1973)
individually adjusted therapy the serum gold
level is maintained above 300 ug per cent.
Concerning child patients I have not found any
earlier reports on serum gold levels with differ-
ent treatment schedules.
In the treatment of children with juvenile
rheumatoid arthritis an empiric schedule of
chrysotherapy has been used according to which
a single dose of Myocrisin should not exceed the
amount of 1 mg/kg of body weight and never be
more than 50 mg. The injections are given
once a week for at least 10 weeks: after that,
the intervals may be prolonged, from fourteen
days to one month.
At our clinic, 125 children with JRA have been
treated by this regimen during the past 10-15
years. When analysing this material, side
effects of the gold treatment were observed in
66 cases (in 53 per cent of the patients), in
several cases various side effects at the same
time.
The age of the children at the beginning of the
treatment ranged between 3 and 15 years. The
frequency of the side effects increased very
clearly with increasing age of the children. (Table
1).
The quality of complications in different age
groups is seen in Table 2. The percentile
amount of proteinuria increased with
increasing age.
The total dose of gold exceeded 1 gr in 35
cases, 2 gr in 10 cases and 3 gr in 3 cases in
the whole material.
Neither the duration of the treatment nor the
total dose of gold in milligrams accounts for the
higher frequency of side effects in older age
groups. (Table 3)
The various age groups did not display any
mutual differences in the percentile amounts of
complications in the groups whose total dose of
gold exceeded 1000 mg.
The frequency of different side effects, calcu-
lated as percentages from the total number of
patients is seen in Table 4.
The most common was proteinuria, observed
in 36% of the cases, haematuria was observed
in 7% of the cases, eosinophilia in 11% and
dermatitis in 1C%.
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