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Chrysotherapy and thrombocytopenia.

R Madhok, T Pullar, H A Capell

    Annals of the Rheumatic Diseases
    |September 1, 1985
    PubMed
    Summary
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    This study identified two patterns of thrombocytopenia in rheumatoid arthritis patients treated with gold. While HLA-DR3 positivity was linked to immune-mediated platelet destruction, HLA typing may not predict all gold therapy toxicity risks.

    Area of Science:

    • Rheumatology
    • Immunogenetics
    • Hematology

    Background:

    • Rheumatoid arthritis (RA) is a chronic autoimmune disease.
    • Gold therapy and penicillamine are treatments for RA.
    • Thrombocytopenia, a low platelet count, can be a side effect of these treatments.

    Purpose of the Study:

    • To investigate the clinical and immunogenetic profiles of patients with RA and thrombocytopenia induced by gold therapy.
    • To differentiate clinical patterns of thrombocytopenia and their association with HLA types.

    Main Methods:

    • Study included 17 patients with rheumatoid arthritis and thrombocytopenia (platelet count < 150,000/mm³).
    • Patients were categorized into two groups based on thrombocytopenia patterns: early precipitous fall (Group I) and less dramatic, fluctuant fall (Group II).

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  • Human Leukocyte Antigen (HLA) typing, specifically HLA-DR3, was performed, and clinical features were analyzed.

    • Main Results:

    • Group I (10 patients) showed early, precipitous thrombocytopenia consistent with immune-mediated platelet destruction and were all HLA-DR3 positive.
    • Group II (7 patients) had a different basis for thrombocytopenia, with only two patients being HLA-DR3 positive. These patients received penicillamine, and four developed thrombocytopenia.
    • Two Group I patients tolerated penicillamine after gold therapy.

    Conclusions:

    • Two distinct clinical patterns of gold-induced thrombocytopenia in RA patients were identified.
    • HLA-DR3 positivity was strongly associated with immune-mediated thrombocytopenia (Group I).
    • HLA typing may not be a reliable predictor for all patients at risk of toxicity during gold therapy.