Patient selection: rheumatoid arthritis, treated with gold salt
Monitoring of immunoglobulins is done:
(1) before starting therapy
(2) after each gram (1,000 mg) of gold
(3) if a severe infection occurs.
Parameters:
(1) serum concentration of IgG in g/L
(2) serum concentration of IgM in g/L
(3) serum concentration of IgA in g/L
(4) presence of recurrent or severe bacterial infections
(5) functional antibody studies
Criteria for immunoglobulin deficiency - one or more of the following:
(1) IgG < 6.5 g/L (< 650 mg/dL)
(2) IgA < 0.6 g/L (< 60 mg/dL)
(3) IgM < 0.4 g/L (< 40 mg/dL)
When to consider discontinuing gold therapy:
(1) IgG concentration < 4 g/L (< 400 mg/dL)
(2) recurrent or severe bacterial infections occur in the setting of reduced IgG, IgA and/or IgM concentrations as listed above
(3) there is a severe defect in antibody production after immunization in the setting of reduced IgG, IgA and/or IgM concentrations
Hopefully the immunoglobulin levels will return to normal once the gold therapy is stopped.
If there is a severe immunodeficiency associated with severe bacterial infection, then intravenous immunoglobulins may be administered.
If none of these problems arise, then gold therapy is continued but the patient should be monitored closely.
