Rhe-2. Intra-muscular gold therapy for rheumatoid arthritis in patients with concomitant hepatitis C infection.A 55-year-old female with seropositive rheumatoid arthritis by ARA criteria was well controlled on alternate week Myochrysine 50 mg IM. The gold was discontinued due to the nationwide shortage of injectable gold. After several weeks, the patient developed a flare of a joint swelling involving multiple small joints of her hands, feet, wrists, elbows, and shoulders accompanied by prolonged morning stiffness and elevated sedimentation rate and CRP C-reactive protein (CRP) A protein present in blood serum in various abnormal states, like inflammation. Mentioned in: Pelvic Inflammatory Disease CRP, n.pr See C-reactive protein. . A hepatitis C test was performed prior to initiating methotrexate methotrexate, drug used in halting the growth of actively proliferating tissues. Introduced in the 1950s, it is used in the treatment of leukemia, psoriasis, and non-Hodgkin's lymphoma. treatment and was positive for hepatitis C and confirmed by hepatitis C RNA RNA: see nucleic acid. RNA in full ribonucleic acid One of the two main types of nucleic acid (the other being DNA), which functions in cellular protein synthesis in all living cells and replaces DNA as the carrier of genetic . A liver biopsy revealed moderate cirrhosis. No methotrexate was given, and the patient continued with pain and swelling for 2 months until gold became available again. After 6 weeks on weekly 50 mg IM gold, her symptoms and swelling improved as did the sedimentation rate and CRP. The patient developed a severe flushing reaction to the IM gold, which required discontinuation of the gold and resulted in a relapse of symptoms and swelling. We have two other patients with rheumatoid arthritis and hepatitis C, who showed similar flares during the nationwide shortage and are currently doing well on IM gold. A review of the literature shows very sparse information on use of IM gold to treat rheumatoid arthritis with hepatitis C. Rheumatoid arthritis plus hepatitis C provides a difficult treatment dilemma due to the potential hepatotoxicity hepatotoxicity (hepˑ·  ·tō·t of most
conventional disease modifying anti-rheumatic drugs Disease Modifying Anti-Rheumatic Drugs (DMARDs)A class of antirheumatic drugs, including chloroquine, methotrexate, cyclosporine, and gold compounds, that influence the disease process itself and do not only treat its symptoms. Mentioned in: Antirheumatic Drugs . The biologic drugs including TNF TNF abbr. tumor necrosis factor TNF, n an abbreviation for tumor necrosis f blockers are being used experimentally in these patients, but the potential risks are high. Gold IM may provide a safer alternative for the patient with rheumatoid arthritis and hepatitis C and perhaps for those patients with hepatitis C and inflammatory arthritis. A pilot study should be performed. Stephen Bagg, BA, and Leonard Serebro, MD. MUSC MUSC Medical University of South Carolina MUSC Maritime and Underwater Security Consultants MUSC Memphis Union Station Company School of Medicine, Charleston, SC. Ochsner Clinic Foundation, New Orleans, LA. |
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion