Gold shots for rheumatoid arthritis

Gold Treatment

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.

Treatment program

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.

Side effects

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.

Proper use of gold treatment

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.

Conclusion

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 Orthopedics 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.

Understanding Biologic Treatments for Rheumatoid Arthritis

Biological response modifiers are the newest class of drugs used to treat rheumatoid arthritis (RA). These modern biologics have greatly improved treatment for many people with RA. Unlike older disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs are made using biotechnology. They are genetically engineered to act like natural proteins in your immune system.

Your doctor may suggest that you start drug therapy right after your diagnosis. This can help combat joint damage. Methotrexate is often the first drug prescribed, but your doctor may give you a biologic drug if methotrexate doesn’t work well enough.

Biologics don’t cure RA, but they can dramatically slow its progression. They also cause fewer side effects than older drugs. People who don’t respond to older RA drugs, such as methotrexate, may benefit from treatment with a biologic. Sometimes biologics may be given alone. Other times they may be given in combination with another type of drug. Taking a biologic drug with methotrexate is effective for most people with RA.

Available biologics

Biologic DMARDs available for rheumatoid arthritis include:

More new biologics are being tested and may be available soon.

Some of these drugs work fairly quickly. Others may take weeks or months to take full effect. Each person responds to these drugs differently, and not everyone responds well to the same drug. Some people may be able to take a biologic alone. However, many people will need a biologic plus an older drug.

How are they given?

Most biologics are given by injection. Some are injected under the skin. Others must be injected directly into a vein.

How do they work?

Biologics work by interrupting immune system signals involved in the damage of joint tissue. Many newer drugs target a protein called tumor necrosis factor (TNF). These drugs are called anti-TNF biologics. Like other DMARDs, biologics affect immune system function.

Specific types of biologics

Biologics are sometimes better at controlling RA progression than DMARDs. This is because they target specific mediators of RA inflammation. Older DMARDs work by suppressing the immune system in general. Modern biologic drugs for RA work in different ways in the body.

Abatacept works by crippling a type of white blood cell called T cells. T cells play a role in the inflammation that causes RA.

Many biologics work by interfering with the activity of tumor necrosis factor. This is a key immune system protein. These drugs include:

  • adalimumab
  • etanercept
  • infliximab
  • golimumab

Rituximab appears to help control RA by destroying another category of immune system cells called B cells. The drug’s activity in the body is complex. These actions are not yet fully understood.

Anakinra blocks the action of an immune system protein called interleukin-1 (IL-1). IL-1 is often called a master cytokine. This is because it controls local and systemic inflammation in the body.

A non-biologic solution

Tofacitinib is in a new class by itself. It’s called a Janus-associated kinase (JAK) inhibitor. It works by blocking a cellular signaling pathway inside cells. This stops components that cause inflammation from being made. Older biologics block inflammation from the outside of cells, but JAK-inhibitors work from within cells. Tofacitinib isn’t injected. It comes as a pill, taken twice per day.

Biologics work for more people because they target specific parts of the immune system to reduce inflammation in the joints. They have fewer side effects than older drugs. However, any drug that suppresses the immune system carries risks.

Side effects can include:

  • severe infections, such as lung infections
  • liver damage
  • reduced ability to make new blood cells
  • nausea
  • pain or swelling at the injection site

Tell your doctor about any unusual symptoms you have. These include a fever or other symptoms that you can’t explain. For instance, biologics can cause a dormant infection to become active again. For this reason, you should have a tuberculosis test before taking one of these drugs.

People with liver disease may not be able to take a biologic drug. If you have liver issues, ask your doctor if biologics are safe for you.

Talk to your doctor

Biologics are the newest type of drugs to treat RA. If you and your doctor are considering a biologic drug, keep the following in mind:

  • Biologics may work better at controlling your symptoms than older RA medications.
  • Most biologics are given by injection.
  • Biologics tend to cause fewer side effects than older drugs. However, like all drugs, they may still cause side effects.
  • There are several types of biologic drugs that work to control your RA a little differently. Work with your doctor to choose the best option for you.

Can Gold Injections Treat Rheumatoid Arthritis?

It sounds like something from a James Bond movie, but gold injections are not fiction. They were one of the original medications developed specifically to treat rheumatoid arthritis and have been used for more than 75 years.

They are considered part of a class of RA drugs known as disease-modifying anti-rheumatic drugs (DMARDs), because gold therapy not only treats rheumatoid arthritis symptoms such as joint pain and swelling, the drugs can also prevent joint damage and disability.

Although gold injections can be effective for some people, their use has declined dramatically in the last 20 years due to the severe side affects and thanks to the advent of more effective and better tolerated biologic and non-biologic DMARDs, such as Trexall (methotrexate) .

How Gold Fights Disease

Two forms of gold therapy are available as an RA treatment. The most common is injectable gold, or gold sodium thiomalate (GST). There is also an oral gold formulation, Ridaura (auranofin), but it’s less effective than the injectable form. Gold is usually given as a weekly injection and may eventually be given monthly.

Although it’s not clear how gold works to treat RA, it’s thought to affect the abnormal immune response involved in triggering rheumatoid arthritis.

It can take a while to see any improvement after treatment with gold therapy. Most people who do respond to the treatment see improvement in symptoms after about three to six months.

Gold Injections: Not for Everyone

As with many other treatments, gold therapy doesn’t work for everyone. Barbara Carley, a consultant in Sarasota County, Florida, had gold injections 40 years ago and remembers that the injections were very painful.

“For me, it did not work,” said Carley. “For some, it works great and can help to bring down inflammation.”

Statistics offer a muted response. According to a review published in the Cochrane Database of Systematic Reviews, people with RA receiving gold injections had 30 percent fewer swollen joints compared to people receiving placebo. The study authors concluded that “although its use can be limited by the incidence toxicity, injectable gold has an important clinically and statistically significant benefit in the short term treatment of patients with rheumatoid arthritis.”

Side Effects from Gold Therapy

Side effects of gold affect about a third of people who use the RA therapy. These include severe skin rashes, skin discoloration, kidney damage, bleeding disorders, and bone marrow suppression. The numerous side effects associated with gold therapy require close monitoring by health care professionals.

A Treatment in Decline

Due to the high number of side effects and limited effectiveness, gold injections are rarely used now. Patients and doctors have largely abandoned them in favor of safer, more effective DMARDs for rheumatoid arthritis.

“They are prescribed with extreme infrequency,” said rheumatologist Jinoos Yazdany, MD, associate professor of medicine at the University of California in San Francisco. “The efficacy and side effects of the newer medications are so good at slowing down the course of the disease that other drugs should be considered first before gold therapy.”

For example, Dr.Yazdany cites a 2009 survey of 7,000 Medicare recipients using medications to treat rheumatoid arthritis that showed only one person was getting gold therapy. And based on 2016 data from the American College of Rheumatology’s RISE registry, which captures medication data from rheumatology practices across the country, Yazdany notes “we continue to see very few patients using gold.”

Yazdany says continuing use of gold therapy may be appropriate for those who have been on the drug for many years and are doing well on it. Otherwise, other DMARDs should be considered as a first line of treatment for people newly diagnosed with rheumatoid arthritis.

Gold for therapeutic purposes

Introduction

Gold compounds are primarily used in the treatment of rheumatoid arthritis. However, they may be useful in the treatment of some skin diseases, including pemphigus vulgaris, epidermolysis bullosa acquisita, and severe or resistant cutaneous lupus erythematosus.

Another name for gold tablets administered orally is auranofin. The trade name in New Zealand is Ridaura®. Gold injection, known as sodium aurothiomalate, is also available.

How to use gold compounds

Gold compounds should only be used by a doctor experienced in its use, as the risk of toxicity is high and side effects potentially dangerous. It is essential that treatment with the drug is not more disabling then the disease it is being used to treat.

Prior to starting treatment with gold compounds a routine baseline assessment should include:

  • complete blood cell count
  • renal function tests
  • liver function tests

Regular monitoring of these should continue throughout treatment.

Similar doses to those used for treating rheumatoid arthritis are given. If there is no improvement by the time the total dose reaches 1g treatment should be stopped.

Contraindications to gold

Gold compounds should not be used under the following circumstances:

  • Progressive renal disease
  • Severe active hepatic disease
  • History of hypersensitivity to gold compounds

Precautions when prescribing gold

Before starting treatment with gold compounds, the following should be considered:

  • Allergies to any medicines, particularly any unusual or allergic reaction to gold or other metals
  • Pregnancy
  • Breast-feeding
  • Other medical problems including:
    • blood or blood vessel disease
    • kidney disease
    • inflammatory bowel disease

Side effects of gold compounds

In addition to their helpful effects, gold compounds may also cause many side effects, some of which can be serious. These include:

  • Skin rashes or itching: usually mild but in some instances may necessitate stopping treatment
  • Ulcers, sores or white spots on lips or in mouth or throat
  • Skin pigmentation due to prolonged treatment (chrysiasis)
  • Loose stools or diarrhoea: usually mild and transient
  • Stomach pain or cramps, bloated feeling, gas or indigestion
  • Decrease or loss of appetite
  • Nausea or vomiting
  • Decrease in white blood count, possibly leading to blood disorders
  • Transient abnormalities in liver and renal function tests
  • Confusion and seizures

Drug interactions with gold compounds

There is very little specific information about interactions of gold compounds with other drugs. However, the potential for increasing gold toxicity is great, particularly when given with other drugs that have an effect on the renal, hepatic and blood systems. Such medicines include penicillamine, aminoglycosides, amphotericin B, penicillins, phenylbutazone, phenytoin, sulfonamides, nonsteroidal anti-inflammatories (NSAIDS), aciclovir and alcohol.

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