Human Leucocyte Antigen Phenotypes and Gold-Induced Remissions in Patients With Rheumatoid Arthritis

Abstract

SUMMARYTo assess possible associations between human leucocyte antigens (HLA) and the achievement of remission during gold treatment, HLA typing was performed in 67 rheumatoid arthritis (RA) patients with a gold-induced remission and in 25 control RA patients who discontinued gold therapy because oflack of efficacy. Both groups of RA patients showed a significantly higher frequency of DR4 antigen and lower frequency of DR6 than a control population. There were no significant differences in HLA antigens between remission-responders and non-responders. It is concludcd that HLA typing is not helpful in predicting the therapeutic response to parenteral gold therapy.

Chrysotherapy: a synoptic review

“…These associations are arbitrarily grouped into three sometimes overlapping groups: (a), Au + and Au + metabolites, including Au(CN) 2 - [1,2,43,51,58,59], Au +3 [2,3,47,51,58,60], and Au o [60,61]; (b), immunomodulatory activity, including alterations of peptides, macrophage phagocytosis, histamine release, monocyte migration, T cells, B cells, and immunoglobulins [12, 14, 36, 38, 42, 44, 51, 53, 62-64, 74, 75]; and (c), others. This last category includes tumor necrosis factor [38, 65 -67]; bone resorption [68]; leukocyte infiltration [69], and leukocyte antigens [39,52]; lysosomal enzymes [1,49]; protein-gold complexes [1,2,70]; polymorphonuclear neutrophils [58,71]; sulfhydryl binding sites [1,72]; superoxide ion radical [4,73]; and thioredoxin reductase, a selenoenzyme [34].…”

“…An association of thrombocytopenia and proteinuria with HLA-DR3 indicates a possible role of HLA molecules in these adverse reactions [52]. However, the association between HLA, especially HLA-type DR3, and gold toxicity is inconsistent and HLA typing is not considered helpful in predicting the therapeutic response to parenteral gold therapy [39].…”

“…Monovalent organogold drugs suppress the rheumatic process in 50 to 70 % of RA patients and induce remission in about 20 % [2,39]. Others do not benefit from gold or suffered side effects that required cessation of treatment [2].…”

“…Auranofin has the advantage of being orally absorbed but is considered less effective than the injectable gold thiolates [1,2]. After more than 70 years of use in the management of RA, chrysotherapy with injectable monovalent organogold salt formulations is now routinely used in the treatment of RA and other diseases having an autoimmune or inflammatory component to their pathogenesis, despite a significant incidence of adverse side effects [3,14,39]. The Empire Rheumatism Council in 1961 confirmed the effectiveness of gold salt treatment for RA and today injectable gold salts are considered a major line of treatment of progressive RA [14].…”

“…Parenteral gold drugs modified the course of RA when given in sufficient dose over a protracted period [46]. Gold drugs, such as sodium gold thiomalate, have been used since 1929 in the treatment of patients with RA and are still considered as important disease modifying antirheumatic drugs [39,47,48]. Approximately 50 % of treated patients are usually markedly improved or cured, but toxic side effects were observed in about 40 % of the cases [1].…”