Major side effects of gold therapy
- 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 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.
Gold is used in a highly selected patient population, given the many treatment options for RA. Patients are typically referred for gold therapy because of one of the following: concerns regarding immunosuppression, coexisting chronic infection, contraindications to other therapies or the failure of such therapies, unavailability of other medications due to excessive cost for the patient or health care system, and pregnancy planning in selected women in whom treatment options may be limited .
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 "Drug-induced lung disease in rheumatoid arthritis", section on 'Gold'.)
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) [2-4]. 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 [4,5].
Subscribers log in hereLiterature review current through: Sep 2017. | This topic last updated: Sep 26, 2017.References
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- OVERVIEW OF GOLD TOXICITY
- POSTINJECTION VASOMOTOR/NITRITOID REACTIONS
- ADVERSE EFFECTS OF CHRONIC THERAPY
- Mucocutaneous effects
- Proteinuria and membranous glomerulonephritis
- Hematologic toxicity
- - Thrombocytopenia
- - Neutropenia and aplastic anemia
- Interstitial pneumonitis
- Diarrhea and enterocolitis
- Other side effects
- MONITORING FOR TOXICITY
- MANAGEMENT OF GOLD TOXICITY
- SUMMARY AND RECOMMENDATIONS