About Gold Treatments for Rheumatoid Arthritis

Gold compounds have been used since the early 1900s to treat rheumatoid arthritis. Although they have recently fallen out of favor among rheumatologists who treat rheumatoid arthritis, they are still used as a treatment of last resort. Gold compounds may be administered as intramuscular injections in a doctor's office or as prescription-only capsules. The most commonly used gold compounds in the treatment of rheumatoid arthritis are gold sodium thiomalate (Aurolate or Myochrysine) and auranofin (Ridaura). Gold aurothioglucose (Solganal) was discontinued in 2002 due to low demand for this formulation.

Function

• Gold compounds are a type of DMARD (disease-modifying anti-rheumatic drug) used to treat rheumatoid arthritis. Although they were the preferred treatment for this condition until the 1990s, they are no longer commonly used. Other treatments, such as methotrexate, anti-malarial drugs and TNF inhibitors are usually preferred because of their lower risk of toxicity. Gold compounds are generally only used when other drugs have failed to provide sufficient relief. How gold compounds work in the treatment of rheumatoid arthritis is not well understood; one theory is that gold compounds block the release of a molecule that causes inflammation in the joints.

Considerations

• Most patients with rheumatoid arthritis will not need to use gold compounds. These drugs are among the last treatments attempted for severe, unremitting rheumatoid arthritis. Although gold compounds are quite effective, they are associated with a variety of unpleasant and sometimes dangerous side effects, which limits their usage. Approximately 35 percent of people who are treated with gold compounds must stop using the medication due to severe side effects. They are effective in 30 to 50 percent of patients with severe rheumatoid arthritis, but typically do not give symptomatic relief for several months after initiating treatment.

Warning

• Gold compounds are associated with many side effects, some of which can be potentially fatal. These medications have been shown to cause birth defects and should not be used during pregnancy; they also pass into breast milk and because of their toxicity should not be taken by nursing mothers. Several drugs can cause interactions when taken with gold compounds, including hydroxychloroquine (Plaquenil) and penicillamine (Cuprimine), both of which are also used in the treatment of rheumatoid arthritis. Close monitoring, including frequent physical examinations and blood tests, are required when being treated with gold compounds.

Effects

• In addition to improving the symptoms of rheumatoid arthritis, gold compounds may cause a number of side effects. Sun sensitivity commonly occurs in people being treated with these medications and can lead to severe sunburns if precautions are not taken. Injected gold compounds can cause an immediate reaction that includes dizziness, nausea, vomiting, fainting and increased sweating. These symptoms usually last for only a few minutes. Some people experience joint pain for 24 to 48 hours following injections of gold compounds. This effect usually becomes less severe or goes away completely after several injections. Other side effects that may occur as a result of gold treatments include soreness of the tongue and mouth, skin rashes, itching, peeling skin, ulcers and sores in the mouth, blood in the urine, abdominal cramps, indigestion, loss of appetite, diarrhea, nausea and vomiting.

Types

• Two gold compounds are currently used in the treatment of rheumatoid arthritis; these are gold sodium thiomalate (Aurolate or Myochrysine) and auranofin (Ridaura). Gold sodium thiomalate is given as an intramuscular injection in a doctor's office, whereas auranofin is prescribed as a once-daily capsule. Gold injections are typically given once weekly for the first 22 weeks, after which they are given less often. Injections are more effective but are associated with more severe side effects.