Gold Treatment.

Last updated Thursday, December 30, 2004

About gold treatment

What is it?

Gold treatment includes different forms of gold salts used to treat arthritis.

Gold is an effective medicine for controlling some types of arthritis and related diseases. In some people, it helps relieve joint pain and stiffness, reduce swelling and bone damage, and reduce the chance of joint deformity and disability.

If your arthritis improves with gold treatment, you may be able to resume many or all of your normal daily activities. But taking gold also involves some risks and precautions.

Does gold cure arthritis?

Gold does not cure arthritis. However, it helps keep the disease under control. Gold treatment relieves the pain caused by active joint swelling. It may also help prevent future joint damage caused by this swelling.

Gold treatment will not repair or correct existing joint damage or deformities. So, it will not reduce the pain or disability caused by these problems. Other types of treatment may be available for these problems.

Does gold help everyone?

Gold treatment does not help everyone. But arthritis usually improves in about one-half of all people treated early in the course of the disease. Many "late starters" may also benefit from gold.

Two or three of every 10 people do not benefit from gold. Another two to three stop taking it for other reasons. It is impossible to tell in advance who will benefit and who will not. The odds, however, are in your favor.

When is gold treatment used?

Gold is used most often to treat rheumatoid arthritis. It is sometimes also used to treat juvenile rheumatoid arthritis and psoriatic arthritis.

Gold appears to work best in the early stages of arthritis, but it may be effective in anyone with active joint pain and swelling. Because the treatment involves certain side effects and inconveniences, it may be used only if your arthritis does not improve with simpler or safer treatments. These include medicines such as aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or cortisone-like drugs (prednisone); in combination with exercise, physical therapy, and rest.

Deciding to use gold treatment

Before recommending gold treatment, your doctor will consider these questions:

  • How severe is your disease?
  • How many joints are affected?
  • Which joints are affected?
  • Will joint damage or disability occur if gold is not used?
  • How has your arthritis responded to other treatments?
  • Is there time to try other treatments before beginning gold treatment?
  • Is there so much joint damage from the arthritis that there will be no significant benefits from gold treatment?
  • Do you have any other condition that would make the use of gold more hazardous (for example, severe anemia, kidney disease, or certain types of skin conditions)?

You and your doctor will work together to decide if gold treatment is right for you.

How does it work?

It is not known exactly how gold compounds help rheumatoid arthritis. It appears that gold affects the process that causes the joint pain and swelling. Until the cause of rheumatoid arthritis is discovered, the way in which gold seems to slow down the disease process probably will remain a mystery.

How long does it take to work?

Gold works slowly and gradually. Most people begin to notice a difference within two to six months after they start taking it.

How long will the effects last?

Your gold treatment may become less effective after several years. There is no way to predict how long gold will continue to benefit you. But you should continue to take it as long as your arthritis improves and you don't have any serious side effects. If you stop taking the medicine while it still benefits you, your arthritis may become active again within several months.

How is it given?

Gold can either be injected into a muscle in the buttock or arm, or be taken in capsule form by mouth (oral gold). You and your doctor can decide which form is best for you. In general, oral gold may cause fewer side effects, but may not be as effective as injectable gold.

Injections

When injected, gold is given as gold sodium thiomalate (brand name: Myochrysine) or as aurothioglucose (brand name: Solganal). Injections must be given by your doctor or nurse. First, you'll be given a small dose, to make sure you do not have a severe reaction to the medicine. Then, you'll gradually be given larger doses until the full dose is reached. The full dose is given every week for four to five months. The dose is then adjusted, depending on how your arthritis improves and whether you have any side effects. When things are going well, the periods between injections will be increased, usually up to four weeks. Since everyone reacts differently to gold, some people will require more frequent injections than other people.

You may notice that your arthritis seems worse for a day or two after a gold injection. This does not always mean you must stop taking injections, but you should report these symptoms to your doctor.

Capsule form

In capsule form, gold is given as auranofin (brand name: Ridaura). It is usually given as two capsules every day. Some doctors prefer to start treatment with a single capsule for the first several weeks. You may be given slightly higher or lower doses from time to time, depending on the side effects and how well your arthritis responds. Never change the dose on your own. Talk with your doctor if you have questions.

About side effects of gold treatment

This page includes some information about side effects of gold treatment.

Remember:

  • Not everyone taking gold will have side effects.
  • Most side effects are minor, but some can be serious.
  • Side effects can occur at any time during treatment with gold.
  • They may also occur for many months after you stop taking it.
  • Talk to your doctor about the side effects; usually, the benefits of the medicine outweigh the risks.

Common side effects

Common side effects of gold treatment include:

Skin rash
The rash is usually itchy, red, and scaly, with tiny bumps. It may appear anywhere on the body, and can eventually cover the whole body. It usually occurs on the chest, arms, and legs. It can also cause sores inside the mouth. The rash can be quite severe and uncomfortable at times. Generally, it is mild and affects only a few spots. It usually goes away on its own within several weeks, if gold is stopped.
Metallic taste, small sores in the mouth, or thinning of the hair
These problems often go away when the dosage of gold is lowered.
Diarrhea or loose bowel movements
These are common side effects of oral gold. This does not mean you'll have to stop taking the medicine. The problem may go away by itself or may go away if the dose is lowered. Taking a bulk-forming laxative may help manage this side effect. If you have loose bowels for more than a few days, or if you have severe abdominal pain or other symptoms, contact your doctor as soon as possible.
Allergy-like reactions
This sometimes occurs shortly after a gold injection. You may feel weak, faint, dizzy or nauseous. This usually goes away after you lie down for a few minutes.

Less common side effects

Less common side effects of gold treatment include:

Damage to the bone marrow
(The bone marrow is where the body produces red and white blood cells and platelets). This is uncommon, but can cause serious problems or even death. Your doctor will take regular blood tests to check for this side effect.
Kidney damage
To detect early signs of kidney problems, urine tests are done repeatedly during therapy.
Liver, intestinal, and lung damage
These have been reported in people treated with gold, but these reactions are very rare. Blood samples, analyzed every few months, should detect the possibility of liver damage.

If any side effects are severe, gold treatment will be stopped. It takes many months for injectable gold to be eliminated from the body, but complete recovery from the side effect usually occurs much sooner. In the meantime, serious reactions may be treated with cortisone-like drugs, medicines that speed the elimination of gold from the body, or other measures.

Gold treatment will work best for you if you take the medicine correctly. Here are some general rules to follow and answers to common questions about taking the medicine.

Interactions with other medicines

Sometimes, gold treatment can be taken with other medicines. Because gold takes a while to begin working, there will be days (during the first four to six months of treatment), when you will have some joint pain and swelling. During this time, your doctor may prescribe other medicines, such as aspirin or other NSAIDs, to help reduce pain and swelling. If the gold is effective, it may be possible to slowly reduce these medicines. Some doctors may also use gold in combination with other, stronger medicines, such as corticosteroids (prednisone).

Always tell your doctor and pharmacist if you are taking any other prescription or over-the-counter medicines. It is important to know how they will interact with the gold.

Pregnancy and breast-feeding

It is not known how gold will affect pregnancy or breast-feeding. Studies in animals show that gold may cause birth defects. Animal studies also show that injectable gold may cause unwanted effects in nursing babies. If you are pregnant, planning to have a baby, or are breast-feeding, discuss the risks and benefits of gold treatment with your doctor.

Children

Gold injections are given to some children who have juvenile rheumatoid arthritis (JRA). Oral gold is also sometimes given to children with JRA, but it has not yet been approved for use in children by the federal Food and Drug Administration (FDA).

Repeat use

Gold may be effective when started again. But you should not take gold again if it caused severe side effects when you last used it.

Injections while traveling

Depending on the length of your trip, you may have to arrange for gold injections as well as for blood and urine tests while you're gone. Talk to your doctor about how and where you can do this.

Alcohol

Talk to your doctor or pharmacist about alcohol and gold treatment. You may be able to drink small amounts of alcohol, if gold injection is the only medicine you're taking. Alcohol may cause increased stomach problems if you're taking oral gold. If you're taking oral gold or other medicines (NSAIDs, prednisone, etc.), you may have to avoid alcohol.

If a dose is missed

Talk to your doctor or pharmacist. Missing only one or two doses will not affect you. But if you miss many doses, the gold will not work as well.

This page contains some things to remember about gold treatments for arthritis.

Do's and don'ts

Do:

  • Take the medicine in the exact amount and at the exact times instructed by your doctor.
  • Read the package insert that comes with your medicine. If you have problems or questions, call your doctor or pharmacist.
  • Before taking gold treatment, tell your doctor:
    • if you are pregnant, planning to become pregnant, or are breast-feeding.
    • if you have any other health problems
    • if you are taking any other prescription or over-the-counter medicines
    • if you have taken gold before and why you stopped taking it
  • Know these facts about your medicine:
    • What is the name?
    • What are the side effects?
    • Why you are taking it?
    • How to take it correctly?

Don't:

  • Do not reduce the dose or stop taking your medicine without contacting your doctor.

Credits

The Arthritis Foundation and the University of Washington Department of Orthopaedics do not endorse any brand name or generic name medication listed here.

For information about arthritis or gold treatment from a variety of sources, contact the National Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Clearinghouse at: National Institutes of Health, 1 AMS Circle, Bethesda, Maryland, 20892-3675, (301) 495-4484, toll free (877) 22-NIAMS

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

Adapted from the pamphlet originally prepared for the Arthritis Foundation by Daniel E. Furst, MD, Norman L. Gottlieb, MD, and Ralph E. Small, PharmD. This material is protected by copyright.