Palindromic arthritis
If there is a favorable response, therapy is tapered to 50mg every 2 weeks for 3 months, then every 3 weeks for 3 months and then finally to a maintenance monthly dose. palindromic arthritis Cv-joints. No response after a total of 1g should be considered a treatment failure. Monthly gold should be continued indefinitely. Usual Time to Maximal Effect: Maximal effect is achieved within 4 to 6 months or after administration of 1g of gold. palindromic arthritis Lower-abdominal-pain. Side Effects: Approximately 35% of patients on gold therapy experience side effects and this often leads to discontinuation of the drug. Prior to each gold injection, patients should have a complete blood count and urine test for protein. The most common reaction is a rash, which can vary from a simple pruritic erythematous patch to a severe exfoliative dermatitis. palindromic arthritis Palindromic arthritis. Ulcerations and mucositis of the mouth, tongue, and pharynx can occur. If a mild mucocutaneous eruption occurs, therapy should be interrupted. If the eruption abates, therapy can be restarted at a 10-15mg weekly, titrating upwards to 50mg weekly with careful monitoring for further rash. Up to 10% of patients have mild proteinuria due to a gold induced membranous glomerulonephropathy that can progress to the nephrotic range. Patients with a positive urine dipstick for protein should be evaluated with a 24-hour urine collection and gold therapy stopped if proteinuria exceeds 500mg/24 hours. Mild proteinuria generally resolves with the cessation of therapy. Occasionally patients will have isolated microscopic hematuria on gold therapy. If monitored closely gold therapy can be continued but other causes of hematuria must be excluded. Immune thrombocytopenia, granulocytopenia, and aplastic anemia occur uncommonly but are absolute indications for cessation of gold therapy. Myochrysine, and less often Solganal, can produce a nitritoid reaction (flushing, dizziness, or fainting) occurring immediately after the gold injection. Rarely, there is a paradoxical increase in musculoskeletal pain that requires discontinuation of treatment. (top of section)Immunosuppressive and other cytotoxic Agents The most commonly used drugs are azathioprine (Imuran), cyclophosphamide (Cytoxan) and cyclosporin A. Because the potential of high toxicity, these agents are utilized for life-threatening extra-articular manifestations or severe articular disease refractory to other therapy.
Palindromic arthritis
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