© 1974 British Society for Rheumatology
review-article |
EOSINOPHILIA DURING GOLD THERAPY*
Department of Rheumatology, University of Wales Heath Park, Cardiff
Department of Rheumatology and Medical Unit, The London Hospital Whitechapel, London E1 1BB
The clinical significance of eosinophilia occurring during treatment of patients with rheumatoid arthritis with sodium aurothiomalate (Myocrisin) has been evaluated. Analysis of differential white cell counts during the first gramme of Myocrisin showed that eosinophil counts in excess of 400/c.mm. occurred at some time in 47% of the 95 patients receiving gold. The earliest onset of eosinophilia was observed after 30 mg. of Myocrisin had been given, and the highest count reached 9,032/c.mm. Eosinophilia was present in 44% of patients with side-effects and in 50% with no adverse reactions. When eosinophilia was associated with toxicity it preceded the reaction in 70% of patients. The degree of eosinophilia did not correlate with the severity of the toxic reaction, but patients with eosinophil counts of 2,000/c.mm. had a high incidence of toxic reactions. The results suggest that routine differential white cell counts are unlikely to be helpfulduring chrysotherapy, but that blood films should be examined and a count made if eosinophilia is suspected, as this may provide warning of impending toxicity. Eosinophil counts in excess of 2,000/c.mm. should be considered a contraindication to further gold.
*Paper read at a combined meeting of the British Association for Rheumatology and Rehabilitation with the Royal Society of Medicine, Section of Rheumatology and Rehabilitation, Cardiff, September 1973.