Table 1. Demographic and epidemiologic features in white rheumatoid arthritis patients receiving gold treatment Toxicity Number of patients Mean age 2 SD Mean age at onset * SD (years) Mean duration of disease 2 SD (years) Males (%) Females 1%) Seropositive (%) Present Absent 38 59.8 2 11.5 45.0 2 12.8 14.5 + 8.2 44.4 55.6 88.9 I10 57.8 2 12.4 43.8 2 12.7 15.8 2 13.7 4U.O 60.0 82.7 side effects (12). Toxic responses to gold therapy in a sample of 30 French patients (13) were reported to be associated with the A1 ,B8,Cw7,DR3 haplotype.
Using our local population of white RA patients treated with gold, we examined the relationship between DR phenotypes and toxic response to gold therapy. We specifically sought to determine if the local white patient sample of gold-treated RA subjects manifesting toxic reactions in general and proteinuria in particular exhibited a pattern of HLA-DK associations similar to that seen in other white populations.
PATIENTS AND METHODS
Patients. The sample of gold-tfeated, white patients was drawn from the outpatient and inpatient facilities of the Division of Clinical Immunology and Rheumatology at the University of Alabama in Birmingham. All patients with either classic or definite RA by American Rheumatism Association criteria (14) who were undergoing chrysotherapy were invited to participate. After an interview and a signed informed consent form were obtained, blood was drawn for HLA typing. Each patient was undergoing therapy with either gold sodium thiomalate or aurothioglucose in a standard protocol.
Patients were included in the study if they had received a minimum of 4 weeks of therapy for those in the toxic category, and no less than 24 weeks of therapy for those in the non-toxic category. Patients were considered as exhibiting no toxic reactions to gold therapy if they did not develop toxic manifestations during the chrysotherapy. Patients were categorized as having developed toxicity to gold if any of the following madifestations appeared during chrysotherapy: proteinuria (3+ or more by the dipstick method on at least 2 different occasions or 2600 mg in a 24hour urine collection), rash, stomatitis, andlor hematologic abnormalities; i.e., leukopenia (<4,000/mm3) or thrombocytopenia (< l00,000/mm~). Seropositivity was defined as a rheumatoid factor titer of 2 1 : 320 on 2 or more occasions, as determined by the latex fixation test (15). * RR = relative risk. t P < 0.005 (versus controls).
$ P < 0.05 (versus controls).