Gold excretion in rheumatoid arthritis.

Abstract

gastroenteritis and other toxic conditions in infants there was extreme hyperuricaemia-20 mg/100 ml was often recorded. With such levels precipitation of urate in the kidney had to be considered.To investigate this possibility experimental production of the syndrome was, effected in rats by blocking the uricase activity with oxonic acid.3 By application of sublethal tourniquet shock in these animals we regularly found hyperuricaemia and massive uric acid precipitation in the renal tubules.4It is possible that "shock" kidney is provoked by this mechanism, and the particular purine metabolism of man may also be the explanation of his special proneness to kidney damage in shock. Forty-eight patients were studied. In 18 patients 24-hour urine collections were made for seven days following an injection of sodium aurothiomalate (Myocrisin) 50 mg. In the other 30 patients a 24-hour urine collection was made during either the second, third, fourth, fifth, or sixth day after injection, selected at random. Aliquots of urine samples and of standard gold solution were irradiated for five minutes in a thermal neutron flux of 1.3 x 1013 neutrons/cm2/second in the DIDO reactor (UKAEA, Harwell). After allowing the 24Na to decay to an acceptable level, the '98Au radioactivity was measured by gamma ray spectrometry.The seven-day excretion studies (18 patients) showed a remarkably flat curve (Fig. 1). In only one patient was a high excretion rate observed (Fig. 2). In this patient most of the injected gold was excreted within the first week, and probably a therapeutic level could not be achieved on conventional dosage. Apart from this patient, the maximum daily excretion of gold during a seven-day period of observation (Fig. 3), the mean daily excretion rate during the second to sixth day following injection, and the daily excretion rate of random 24-hour sample. during the same period (Fig. 4) all showed variation within a relatively narrow range only.We conclude that following an injection of sodium aurothiomalate for rheumatoid arthritis in most patients the gold is excreted slowly and fairly uniformly. In our experience, the type of hyperexcretion envisaged by Smith et al.I is a rare occurrence.We thank the East Anglian Regional Hospital Board who sponsored this research, and Messrs.May and Baker who contributed to the cost of the activation analysis.-We are, etc., R.

Clinical response and serum gold levels in chrysotherapy. Lack of correlation.

“…Efforts to accomplish this have included the measurement of urinary gold excretion (Jones, Ahmed, and Chan, 1971) and attempts to individualize gold dosage based on the clinical responses of the patients wherein dosage is increased until either beneficial effect or toxicity occurs (Smith, Pea, Kron, Hermann, Del Toro, and Goldman, 1958). More recently, another effort to improve the precision ofgold therapy by the monitoring of serum gold levels (Rothermilch, Bergen and Philips, 1967;Lorber, Chang, Friou, and Starr, 1969) has been proposed.…”