HOW LOW CAN YOU GO - USE OF VERY-LOW DOSAGE OF GOLD IN PATIENTS WITH MUCOCUTANEOUS REACTIONS

Objective. We identified a group of patients with rheumatoid arthritis (RA) who were sensitive to both the beneficial and the side effects o f intramuscular (im) gold treatment and whose disease was well control led with doses of gold between 2 mg every 6 weeks and 5 mg weekly. We describe the clinical course of these patients and their management ai med at maximizing the effectiveness of gold therapy. Methods. Patients successfully treated with maintenance doses of im gold (<20 mg/mo and not more than 10 mg/dose) were identified by chart review. Clinic rec ords were reviewed to extract clinical and laboratory data. Results. T he population consisted of 11 female and 2 male patients with RA. Elev en were seropositive and 2 had Felty's syndrome. All developed mucocut aneous side effects within 20 weeks of beginning im gold therapy, at a time when RA had improved markedly compared to pretreatment status. S ide effects recurred with sequential dosage adjustments so that doses >10 mg were not tolerated. Side effects were managed by temporary disc ontinuation of gold until side effects resolved and resumption of trea tment using usually 50% lower dosage. When side effects recurred the d osage was reduced further by 50%. Final maintenance dose was 2 mg ever y 4 weeks in 1 patient, 2 mg weekly in 1, 3 mg weekly in 3, 5 mg month y in 1, 10 mg every 3 weeks in 2, 10 mg every 4 weeks in 2, 10 mg ever y 6 weeks in 1, and 5 mg weekly in 2 patients. All patients improved a nd 6 are in complete remission. Mean duration of therapy was 5.5 yrs. Conclusion. The minimum effective dose of im gold is not known. Dose a nd dose intervals should be individualized for optimal benefits and to lerability.