Gold is used in the treatment of rheumatoid arthritis (RA) and has also been used for the treatment of other rheumatic and autoimmune diseases, including psoriatic arthritis and pemphigus vulgaris. Its use is limited by a high incidence of side effects, a requirement for close clinical and laboratory monitoring, and the need for gold sodium thiomalate (GST), the more efficacious form of gold, to be administered by periodic intramuscular injection.
The major side effects of gold therapy and their management will be reviewed here. The use of gold compounds for the treatment of rheumatic disease and the pulmonary adverse effects of gold therapy are discussed in detail elsewhere. (See "Use of gold compounds in rheumatic diseases" and "Gold-induced pulmonary disease".)
OVERVIEW OF GOLD TOXICITY
Side effects occur in approximately 30 percent of patients treated with parenteral gold compounds, and are the most common reason for discontinuing gold therapy (table 1) [1-3]. The following major points should be noted:
●The most common side effects are pruritus, dermatitis, stomatitis, and proteinuria (see 'Mucocutaneous effects' below and 'Proteinuria and membranous glomerulonephritis' below). These toxicities typically present within the first six months of therapy, and occur more frequently in patients treated with gold sodium thiomalate (GST), the parenterally administered preparation, compared with auranofin, which is taken orally. Loose, soft stools are a common side effect of auranofin, and watery diarrhea may occur in up to 5 percent of patients on this drug [3,4].
The presence of HLA-DR3 is associated with an increased risk of nephropathy and of immune thrombocytopenia related to gold therapy .
●Postinjection reactions may occur, including vasomotor reactions to GST injection, which occur in about 5 to 7 percent of patients and may be seen at any time over the course of treatment. Rarely, patients may experience postinjection arthralgia or worsening of arthritis during the first few weeks of therapy. (See 'Postinjection vasomotor/nitritoid reactions' below and 'Other side effects' below.)