Norman L. Gottlieb

Adverse Reactions With Oral and Parenteral Gold Preparations

SummaryAuranofin (triethylphosphine gold), an oral gold preparation, has recently been made available, and along with injectable gold preparations, is of therapeutic value for rheumatoid arthritis. Serious gold toxicity is uncommon, and drug-related deaths rare. Many potential adverse reactions are similar, including dermatitis, stomatitis, thrombocytopenia, leucopenia, and proteinuria, generally with increased incidence in the injectable gold-treated patients. Oral gold is associated with benign lower gastrointestinal side effects, including diarrhoea, loose stools and abdominal cramps that are often dose-related and resolve spontaneously. The incidence of severe reactions such as thrombocytopenia, aplastic anaemia and exfoliative dermatitis is lower with oral gold than injectable preparations, and contributes to a superior risk-benefit ratio. The treatment of gold toxicity depends on the type and extent of organ involvement.

Rheumatic disorders associated with viral infection

R HEUMATIC COMPLAINTS accompany a variety of viral infections. Although this subject has been reviewed previously in a major journal,’ the literature has expanded considerably in recent years, especially regarding the relationship between hepatitis B virus and several rheumatic syndromes. In addition, accumulating evidence suggests that viral agents may be involved in the pathogenesis of certain collagen-vascular diseases, particularly systemic lupus erythematosus.‘-’ This contribution reviews the articular complications of viral infections, emphasizing recent advances.

Primary Familial Bilateral Carpal Tunnel Syndrome

We identified bilateral carpal tunnel syndrome in 19 of 43 living persons of a nonconsanguineous family. No single common etiologic feature was seen. Sixty-three percent of the afflicted kindred had symptomatic digital flexor tenosynovitis. Noninflammatory thickening of the flexor retinaculum or tendon sheaths, or both, was the commonest surgical finding. The 44% prevalence, early age of onset, and equal sex ratio differ from idiopathic carpal tunnel syndrome. Family pedigree suggests an inheritable disorder transmitted by an autosomal dominant gene with a high degree of penetrance.

Gouty arthritis in the black race

This review of 65 black-black patients with gout, in contrast to tan or tinted, is presented to emphasize the universal nature of the disease, irrespective of race or geographic region. One case of a female who delivered a living child 4 yr after her initial attack of gout is reported. No case of gout secondary to chronic renal disease, or to a blood dyscrasia, including sickle cell disease, was discovered. Except for the race, aberrant sex distribution and low incidence of urate stones, this series is not unlike a series of white gout patients.

Introduction: The art and science of nonsteroidal anti-inflammatory drug selection

In science, the total absorption of the individual event in the generalization is the goal; on the other hand, the humanities are concerned rather with providing for the special meaning of the individual event within an appropriate general system. Moody E. Prior, Science and the Humanities (1962)