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Open Access Highly Accessed Research article

Rheumatoid arthritis, gold therapy, contact allergy and blood cytokines

Åke Svensson1*, Halvor Möller1, Bert Björkner1, Magnus Bruze1, Ido Leden2, Jan Theander2, Kjell Ohlsson3 and Carina Linder3

Author Affiliations

1 Department of Dermatology, Malmö University Hospital, Sweden

2 Department of internal medicine, Section of Rheumatology, Kristianstad Central Hospital, Kristianstad, Sweden

3 Department of Surgical Pathophysiology, Malmö University Hospital, Sweden

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BMC Dermatology 2002, 2:2  doi:10.1186/1471-5945-2-2

Published: 1 February 2002

Abstract

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.