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| Authors | C Mallia D Aquilina L A Azzopardi |
| Abstract | Background: Nitritoid reactions are vasomotor reactions occurring following the administration of sodium aurothiomalate (gold). Objective: To report the occurrence of nitritoid reactions in rheumatoid arthritits patients attending the Gold Clinic at St Lukes Hospital. Method: Patients who developed nitritoid reactions were identified by the Rheumatology Nurse. Case notes, review of their medication was taken in order to identify risk factors. Results: Out of 38 patients on gold injections 5 (13.2%) developed nitritoid reactions. Four were females and one was male. Age range at onset of reaction was 54-73 years (mean 65.2, SD: 7.46). Duration of gold therapy prior to nitritiod reaction ranged from 1 week to 7 years 8 months. None of the patients had previously experienced vasomotor side effects. Two patients developed the reaction following their first 50mg dose. One patient developed the nitritiod reaction with 50mg first dose after having stopped treatment for 12 months due to disease remission. Two patients developed the reaction following 50mg and 25mg doses respectively. All 5 patients were hypertensive. Four patients were on angiotensin converting enzyme inhibitors at the time of the reaction. One patient had just started therapy with an angiotensin converting enzyme inhibitor. Three patients were on an angiotensin converting enzyme inhibitor in combination with other anti-hypertensive drugs and had severe nitritoid reactions. Conclusion: Nitritoid reactions are more likely to occur with concomittant administration of angiotensin converting enzyme inhibitors and gold. Parameters such as blood pressure and ECGs are required during recovery of the patient. |
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| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
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| Key words | ACE inhibitor, gold, rheumatoid arthritis, nitritoid reactions |