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Nitritoid reactions: case reports, review, and recommendations for management
A B Arthur1, A Klinkhoff, A Teufel
1Mary Pack Arthritis Program, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
The Journal of Rheumatology
|October 24, 2001
Summary
Nitritoid reactions are a known side effect of gold sodium thiomalate (GST) therapy. This study identifies risk factors and management strategies for these reactions in patients undergoing chrysotherapy.
Area of Science:
- Rheumatology
- Pharmacology
Background:
- Chrysotherapy, using gold sodium thiomalate (GST), is a treatment for certain rheumatic conditions.
- Nitritoid reactions are a recognized adverse effect, occurring in approximately 5% of patients on GST.
Observation:
- A chart review of 8 patients experiencing nitritoid reactions during gold monitoring was conducted.
- Patient demographics included ages 36-69, with 7 of 8 being female.
- Reactions occurred after 13 months to 13 years of gold therapy; 7 patients had prior mucocutaneous reactions.
Findings:
- Two patients were concurrently using angiotensin-converting enzyme (ACE) inhibitors.
- Seven reactions were mild, while one was severe, presenting with hypotension, syncope, and angina.
- One patient developed gold dermatitis post-nitritoid reaction.
Implications:
- Management requires a high index of suspicion for symptoms like nausea, flushing, or dizziness post-injection.
- Switching to gold sodium aurothioglucose, administering injections recumbently, and post-injection observation are recommended.
- These strategies aim to mitigate the risk and severity of nitritoid reactions in chrysotherapy.
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