Mucocutaneous side effects and continuation of aurotherapy in patients with rheumatoid arthritis

To examine the possibility of the continuation of therapy after achieving clinical improvement in patients with mucocutaneous side-effects of parenteral gold compound therapy (Tauredon, "Byk Gulden", Germany).

40 patients with active seropositive rheumatoid arthritis (average age 42.8 years, average duration of disease 2.8 years) received Tauredon in a dosage of 50 mg/week intramuscularly. 19 patients (47.5%) developed mucocutaneous side effects. Four of them were excluded from the study because of severe skin reactions. In 15 patients with mild or moderate side-effects (local skin rash and stomatitis) aurotherapy was continued after the resolution of adverse reactions. Four out of the 15 patients were withdrawn from the study after restarting the lower dose treatment due to recurrence of dermatitis. 11 out of 19 patients finished 1 year of study with low dose Tauredon. Clinical remission occurred in 4 patients (36.4%) while improvement was registered in 6 patients (54.5%). In one patient (9.1%) no clinical effect was observed. None of these 11 demonstrated any Tauredon toxicity.

The development of mucocutaneous side-effects should not be considered as an absolute contraindication for the continuation of gold compound therapy. A low dose regimen may allow maintenance of therapeutic effect and improve tolerance in this group of patients. Gold salts, such as disodium aurothiomalate (ATMO have been used in the treatment of rheumatoid arthritis (RA) for over 70 years. They suppress inflammation and retard radiological progression of joint damage [1], but their use is limited by a high incidence of toxic side-effects in about 30% of patients. The commonest side-effect of chrysotherapy is skin toxicity, accounting for up to 60% of all adverse reactions [2]. Rash is most frequent in the first year of therapy, but can occur at any time. Stomatitis occurs in 1-12% of patients and may occur concomitantly with skin rash. The causes of skin rash and stomatitis are still unknown. When mucocutaneous reactions develop, the drug should be withheld until the condition resolves [3]. Approximately 2-3% of patients have to stop treatment because of severe skin rash and mouth ulcers [4]. However we, together with other authors [5, 6, 7, 8, 9] consider that mild to moderate mucocutaneous reactions are not an absolute contraindication for the continuation of gold therapy. The aim of our study is to examine the possibility for the continuation of therapy after achieving clinical improvement in patients with skin rash and stomatitis as a result of treatment with ATM (Tauredon, "Byk Gulden", Germany).