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

Reactivation of Acute Inflammation by Methotrexate*

ABSTRACTDuring treatment for malignant disease with antimetabolites a few instances of photosensitivity have been reported. This phenomenon was studied experimentally in patients receiving methotrexate for psoriasis. An acute dermal inflammation was elicited through repeated exposure to ultraviolet light during the days preceding a single intravenous injection of the drug.When ultraviolet light was given four days before methotrexate, or simultaneously with the injection, the regular rise and slope of inflammatory intensity was registered in the skin. When ultraviolet light was given one or two days before the injection of methotrexate the drug influenced the course of inflammation towards a diphasic curve. Thus, methotrexate when administered in proper time reactivates a receding inflammatory process.It is concluded that exacerbations of irradiation erythema in patients on cancer chemotherapy provide examples of “false photosensitivity”

Contact allergy to gold as a model for clinical-experimental research [Elektronisk resurs]

The high frequency of contact allergy to gold in patients with dermatitis was established after exhaustive skin testing, determining the right test agent, the best concentration, and repeated test readings. Metallic gold in contact with skin is slowly ionized, permitting absorption and haptenisation. Contact allergy to gold is statistically correlated to the presence of dental gold. But in many case reports it has also been attributed to wearing gold jewellery, albeit not statistically demonstrated. Epicutaneous testing with gold salts increases the blood gold level, and by intramuscular injection systemic contact dermatitis is provoked in an allergic individual. In coronary heart disease, gold-coated intravascular stents have been shown to be correlated to contact allergy and even to an increased risk of restenosis. Gold is far from inert