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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. A hepatitis C test was performed prior to initiating methotrexate treatment and was positive for hepatitis C and confirmed by hepatitis C RNA. 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 of most conventional disease modifying anti-rheumatic drugs. The biologic drugs including TNF 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 School of Medicine, Charleston, SC. Ochsner Clinic Foundation, New Orleans, LA.
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Title Annotation:Section on Rheumatology
Author:Serebro, Leonard
Publication:Southern Medical Journal
Article Type:Brief Article
Date:Oct 1, 2004
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