Læknablaðið : fylgirit - 01.05.1978, Síða 51

Complications under qold trcatmgnt
FEVER
HEADACHE
THROMBO-
CYTOPENIA
EOSINOPHILIA
DERMATITIS
HAEMATURIA
PROTEINURIA
NATRIUMAUROTHIOMALATE mg (total given amount)
Fig. 2 Occurence of different side effects during
gold therapy.
44 per cent of the side effects were observed
before the total dose of gold exceeded 500 mg.
(Figure 2)
Kidney biopsy was made in 31 cases with
proteinuria, 10 findings were histologically normal,
2 cases displayed amyloidosis, and 19 cases other
pathological findings including local glomerulitis,
basement membrane thickening, adhesions and
lobulation, tubular casts and tubular atrophy
together with interstitial round cell infiltration.
Most of the histological findings may be due to
the primary rheumatic disease itself. Amyloidosis
for example cannot be classified to belong to the
side effects of the gold treatment. The two cases
with amyloidosis were excluded from the series.
An interesting correlation was observed between
the existence of a rheumatoid factor and renal
involvement. (Table 5) Only 7 patients in this
series showed definitely positive Waaler-Rose
reaction. All but one of these patients had
pathological urinary findings, and in four cases
kidney biopsies showed pathological changes.
After these results, increasing age and
seropositivity seem to have positive correlation
to renal changes. Long duration of the
disease inan additional factor. In 10 cases,
the duration of the disease was more than 5 years
before the beginning of gold treatment. Five of
these patients reacted with proteinuria or
haematuria against the gold treatment.
It seems likely, that the seropositive, adult
type of rheumatoid arthritis is more susceptible
to nephropathia in the connection of gold treat-
ment, and the risk increases with the long
duration of the disease.
Serum gold levels were estimated by
atomic absorption spectrophotometry. As in
adults, an abrupt rise in serum gold levels
occurred in a few hours after the intramuscular
injection. The peak was reached in two hours
after the injection in most of the cases. After
that, serum gold levels decreased rapidly during
the next 36 hours and more slowly thereafter
until the next injection.
If the patient is given long-term therapy with
one injection a month, the dose being 0,68 mg/
kg of body weight, the curve of serum gold
levels looks like in Figure 3. The peak value
after 1 to 3 hours is about 500 Uf*7o. Next
morning the serum level is about 400 ug% and
pmol/l pg/IOOml GOLO SERUM CONCENTRATIONS
Myocrisin IM TIME (WEEKS)
Fig. 3 Serum gold levels in a 10-years old girl
receiving long-term chrysotherapy with
monthly gold injections. (0,68 mg/kg of
Myocrisin^)
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