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From the analysis of literature and first-hand data on methylprednisolone pulse-therapy for rheumatoid arthritis (RA) the conclusion is made that such therapy produces a rapid and pronounced though short-term effect on the disease activity. It fails to stop RA progression. A case of two-wave effect is attributed to restoration of target cell sensitivity to chrysotherapy.
Gold salts are still a first choice for treatment of rheumatoid arthritis. Although adverse reactions are relatively frequent, hepatic abnormalities are rare. They consist largely of reversible cholestasis, and, exceptionally, the evolution can prove rapidly fatal due to extensive hepatic necrosis. We present an additional case of this kind which occurred after a total dose of 450 mg intramuscular Aurothiopropanol over 6 weeks. The pathogenetic mechanism is complex, toxic and/or immuno-allergic. Nevertheless, regular hepatic enzyme testing is not recommended.
Analysis is made of the results of the treatment with parenteral (crysanol and myochrysine) and oral (ridaura) gold drugs as well as with small doses of D-penicillamine (DP) of patients suffering from rheumatoid arthritis with the signs of nephropathy. The latter ones were identified, respectively, in 18 out of 80 patients who began receiving treatment, in 17 out of 72, and in 16 out of 61 patients. The clinical, laboratory, instrumental and morphological manifestations of nephropathy are described and analysis of their dynamics under the treatment impact is provided. It is noted that these types of basic therapy produce a beneficial effect on the manifestations of rheumatoid nephropathy. That referred to a greater measure to the gold drugs than to the small doses of DP. The degree of counteracting the symptoms of renal pathology agreed well with a good clinical effect in respect to the articular syndrome and inflammatory responses of blood. Among patients receiving crysanol, iatrogenic nephropathy was recorded in 8.75% of cases, among those on ridaura, in 2.8%, and those on DP, in 8.2% of cases. The authors provide evidence for the use of gold drugs and DP in patients suffering from rheumatoid nephropathy.
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Chrisanol therapy was provided to 172 men suffering from Reiter's disease, having histocompatibility antigen B35 and its combination with B27 as well as B17 and B11 indicating that the articular syndrome may run a persistent and grave course. Chrisanol therapy brought about a decrease of the activity of complement, lysozyme, bactericidal activity of blood serum, a reduction of the content of serum IgG, and autoimmune reactions parameters. Chrisanol therapy was tolerated well. The ten-year follow-up revealed relapses in 8.3% of the patients.
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Wilson's disease is named after Kinnier Wilson (1878-1937), a famous British neurologist. It is an inherited condition, due to an excess of copper in the liver and brain. The mechanism is unknown, but the gene has been mapped to chromosome 13. The worldwide prevalence is about 30 per million. Patients present with liver disease and/or neuropsychiatric manifestations. Early diagnosis is crucial because there is an effective treatment. This treatment, usually with penicillamine, must be continued for life and without interruption. Liver transplantation may be lifesaving in patients with fulminant hepatitis, or with severe liver disease which is unresponsive to treatment.
One hundred and twenty nine children with chronic lead poisoning were followed from August 1985 to July 1989. Old lead paint was recognized as the contaminant source at home. Pica of paint flakes was the main mode of intoxication. Children were classified according to the Center for Disease Control 1985 as follows: class IV (39 cases), class III (45 cases), class II (30 cases), class I (15 cases). Nineteen of those in class IV had blood lead levels above 700 micrograms/l and received BAL + EDTA followed by EDTA alone for a mean of 4.6 +/- 3.5 courses. With this treatment, blood lead level decreases were 50 +/- 17%. Nine of these class IV children had an evaluation at last 3 months after the last chelation course: 5 became class I or II, and 2 class III with a negative provocative test. The remaining 20 children in class IV were given a mean of 2.7 +/- 1.4 courses of EDTA. Blood lead levels decreased by 52 +/- 15%; 11 children were evaluable at least 3 months after the last chelation course: 4 became class I, and 7 class II. Thus overall 80% of class IV moved under treatment to class I or II. Among those 45 children in class II, 30 underwent a provocative test and 24 one to three courses of EDTA: 8 were further studied: 3 became class I and 5 class II. Combination of screening, medical treatment and sociocultural approach led to avoid acute effects of severe chronic childhood lead poisoning. The efficacy of such an approach in preventing chronic effects has still to be evaluated.
Proton nuclear magnetic resonance spectroscopy (1H NMR) was used to determine the relative binding constants for several arsenical-dithiol adducts. The compounds investigated were 2,3-dimercaptopropanol (British anti-lewisite; BAL), 1,2-ethane dithiol (ET), and 1,2-propane dithiol (PDT). It was found that PDT has a significantly higher affinity than ET or BAL for phenyldichloroarsine (PDA) in methanol.
A case report is presented describing a worker who was splashed with arsenic acid in an industrial accident and subsequently developed symptoms of systemic arsenicalism and peripheral neuropathy. This is the only report, to the authors' knowledge, of a single episode of cutaneous absorption of arsenic resulting in peripheral neuropathy. Previous reports of arsenical neuropathy and rationale for BAL therapy early in the treatment of systemic arsenicalism are discussed.
Results are reported of changes of the level of lipid peroxidation in 51 patients with rheumatoid arthritis depending on the stage of activity of the inflammatory process and employment of non-steroid antirheumatic agents and gold preparations (crysanol). The authors discusses the problem of relative antioxidant insufficiency in rheumatoid arthritis and antioxidant properties of crysanol.
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Auranofin, the orally effective gold compound, stimulated the canine colonic epithelium in vitro. It increased short circuit currents across both the innervated mucosal and functionally "nerve-free" epithelial preparation, when added to either the luminal or serosal solutions. Serosal responses were inhibited by tetrodotoxin (TTX). A hydrophilic gold compound, sodium aurothiosulphate produced similar effects but only on serosal addition. Gold compounds can thus alter colonic transport activating enteric nerves and releasing a neurotransmitter. Thus gold induced diarrhea could have a significant neural component.
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The authors studied the activity of alkaline and acid phosphatase (AP), myeloperoxidase (MP), the level of cationic protein (CP), spontaneous and pyrogenal-induced tests of restoration of nitroblue of tetrazolium (HCT-test) in the blood and synovial fluid (SF) neutrophils in 116 patients with rheumatoid arthritis (RA) in the dynamics of a 3-4-week and subsequent 6-month therapy with chrysanol, salazopyridazine and delagil. In the active phase all the patients exhibited an abrupt increase in the activity of alkaline and acid phosphatase in blood neutrophils, a drop in the level of CP (in 69%), a rise in the activity of MP (in 32%); pyrogenal did not induce any capacity for restoring HCT (in 44%). Indices of alkaline and acid phosphatase in blood and SF neutrophils and also of the induced TCT-test in blood neutrophils correlated with the degree of RA activity. Statistically significant positive cytochemical shifts were noted only after 6 months of treatment: a decrease in alkaline and acid phosphatase activity, a rise in the level of CP, MP and capacity for restoration pf HCT with pyrogenal in blood neutrophils. Increase in the correlation of CP or MP levels by 0.2 or more in blood and SF neutrophils, and also of the normal level of CP in blood neutrophils or its increase not less than by 15% 3-4 weeks after the beginning of therapy evidence good prognostic informativeness with respect to the effectiveness of basic therapy.
Patients with rheumatoid arthritis showed changes of the fatty acid spectrum manifested in a reduction of the polyunsaturated acids (linoleic, linolenic, arachidonic) and an increase of the level of monounsaturated (oleic, palmithooleinic) depended on the course of the disease. Antirheumatic treatment produced a positive effect, especially gold preparations, on normalization of the level of unsaturated fatty acids in rheumatoid arthritis.
The effect of mercury on renal lysosomal protein digestion was studied after administration of mercury in vitro and in vivo. Mercuric chloride or methylmercury chloride was added in vitro to lysosomal enzymes isolated from normal rats, and subsequently, digestion experiments were carried out using 125I-labeled lysozyme or cytochrome c as substrate proteins. Both mercury compounds produced a concentration-dependent inhibition of the degradation of the proteins, mercuric chloride being the strongest inhibitor. Mercuric chloride was also administered to rats in vivo for 5 to 8 months. Renal lysosomal enzymes from these animals also had a decreased ability to digest for the two substrate proteins. Furthermore, the digestion of lysozyme intravenously injected into mercury-intoxicated rats was decreased in renal cortical slices incubated in vitro. Electron microscope autoradiography showed that intravenously injected labeled lysozyme was located primarily over lysosomes in proximal tubule cells 1 hour after injection in both control animals and mercury-intoxicated rats. These results suggest a decreased catabolism of low molecular weight proteins in the kidney during chronic mercury intoxication.
Ten patients with rheumatoid arhritis treated with gold sodium thiomalate developed thrombocytopenia without bone marrow asplasia. There was no life-threatening blood loss, but petechiae, purpura, or echymoses were seen in eight patients. The serum gold levels monitored in one patient did not exceed levels seen in patients without thrombocytopenia. In three cases peripheral blood lymphocytes were cultured in the presence of gold and tritiated thymidine incorporation was significantly increased. Eight patients responded to steroid therapy, one patient to BAL and pencillamine, and one patient to vincristine.