Haematuria occurring during antirheumatoid therapy

Area of Science:

• Rheumatology
• Nephrology
• Pharmacology

Background:

• Gold and penicillamine are disease-modifying antirheumatic drugs (DMARDs) used for rheumatoid arthritis.
• Hematuria is a potential adverse effect of these treatments, necessitating careful monitoring.
• Understanding the implications of hematuria during DMARD therapy is crucial for patient management.

Purpose of the Study:

• To retrospectively analyze the occurrence and management of hematuria in patients treated with gold and penicillamine.
• To assess the relationship between hematuria and continued treatment with gold or penicillamine.
• To evaluate the impact of unexplained hematuria on renal function.

Main Methods:

• Retrospective review of 191 patients treated with gold and/or penicillamine over seven years.
• Identification and analysis of patients experiencing hematuria during treatment.
• Assessment of identifiable causes for hematuria and treatment discontinuation decisions.

Main Results:

• 10% of patients exhibited hematuria during the study period.
• Identifiable causes for hematuria were found in over half of affected patients.
• Penicillamine was discontinued for unexplained hematuria; gold therapy continued without adverse effects or renal function decline.
• Two patients continued to experience unexplained hematuria after penicillamine discontinuation, with no renal deterioration or proteinuria.

Conclusions:

• Unexplained hematuria in patients on penicillamine warrants discontinuation of the drug.
• Gold therapy can often be continued safely in the presence of hematuria, without compromising renal function.
• Hematuria alone, particularly without proteinuria, may not necessitate cessation of gold treatment for rheumatoid arthritis.