Use of gold compounds in rheumatic diseases
- Alice Klinkhoff, MD
Alice Klinkhoff, MD
- Clinical Associate Professor
- University of British Columbia
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
Gold compounds have been employed for the treatment of rheumatoid arthritis (RA) since Forestier pioneered their use for this purpose in 1929 . Subsequent randomized trials confirmed the effectiveness of gold in RA (see 'Efficacy of parenteral gold in RA' below). Gold has also been used in psoriatic arthritis and juvenile idiopathic arthritis. However, since the 1980s the use of gold has declined due to multiple advantages of other medications, particularly methotrexate (MTX), when compared with gold; the benefits of these newer medications include convenience, safety, efficacy, and cost.
The pharmacokinetics and use of gold in the treatment of RA are reviewed here. The toxicities of gold therapy, the initial treatment of RA with disease-modifying antirheumatic drugs (DMARDs), and the treatment of RA resistant to initial DMARD therapy are discussed in detail separately. (See "Major side effects of gold therapy" and "Initial treatment of rheumatoid arthritis in adults" and "Treatment of rheumatoid arthritis in adults resistant to initial biologic DMARD therapy", section on 'Resistant to standard therapies' and "Treatment of rheumatoid arthritis in adults resistant to initial nonbiologic DMARD therapy".)
Therapeutic gold compounds — Two therapeutic products containing gold are available:
●Gold sodium thiomalate (GST), which contains almost 50 percent gold in a water-based solution and is administered by intramuscular (IM) injection every one to four weeks.
●Auranofin, which is a gold triethylphosphine compound taken orally each day.
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- Therapeutic gold compounds
- Mechanism of action
- Drug interactions
- USE OF GOLD IN RA
- Dose schedules
- - Dosing of parenteral gold
- - Dosing of oral gold
- Contraindications and precautions
- Pregnancy and lactation
- Monitoring for toxicity
- - Monitoring parenteral gold
- - Monitoring oral gold
- Duration of therapy
- EFFICACY OF GOLD THERAPY
- Efficacy of parenteral gold in RA
- - Gold versus placebo
- - Gold versus other DMARDs
- - Gold combined with other drugs
- - Long-term effectiveness
- Efficacy of oral gold
- Determinants of efficacy
- USE IN DISORDERS OTHER THAN RA
- SUMMARY AND RECOMMENDATIONS