Gold for Rheumatoid Arthritis - Is It Still Used?

Gold Was Once the Standard Treatment for Rheumatoid Arthritis

Gold for rheumatoid arthritis
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In the past, gold shots were the standard treatment for moderately to severely active rheumatoid arthritis. Gold compounds have been used for rheumatoid arthritis since 1929. Gold was actually developed as a treatment for tuberculosis. At that time, it was mistakenly thought that tuberculosis and rheumatoid arthritis were related conditions. While that proved to be incorrect, gold still showed a beneficial effect on rheumatoid arthritis.

Gold is available in parenteral (not oral) forms [Myoschrysine (aurothiomalate) and Solganol (aurothioglucose)] and as oral gold [Ridaura (auranofin)]. As newer treatments became available with superior benefit and less risk, gold injections are now rarely given to treat rheumatoid arthritis. Its use diminished due to the risk of side effects, the need for close clinical and laboratory monitoring, and because the more effective form of gold requires intramuscular injection, making it less convenient. 

How Is Gold Administered?

If prescribed, gold shots are given intramuscularly in the doctor's office weekly for the first 20 weeks of treatment and then the frequency is tapered to every 3 - 4 weeks. A blood count and urine test are recommended before each gold shot to make sure it is safe to give.

Intramuscular injection of gold is usually administered at first as a small 10 mg dose once a week.

A second 25 mg dose follows and then 50 mg a week until a response is achieved, up to  a total of 750-1000 mg.

Side Effects Make Gold a Challenging Treatment

The most common side effects associated with intramuscular gold included, pruritis, dermatitis, stomatitis, and proteinuria. With oral gold, loose stools are a common side effect, with watery diarrhea occurring less often.

Nephropathy and thrombocytopenia can develop while treated with gold. 

While potential side effects have been the downside of treatment with gold, it must be noted that gold injections placed some patients into permanent remission. Rheumatologist Scott J. Zashin, M.D, commented, "As a result, if a patient has gotten a good response to gold injections, they are typically continued. Stopping the gold in these patients may trigger a recurrence of arthritis activity which may not respond to resumption of therapy with gold."

However, as gold shots have become less utilized in treatment as newer treatments were developed, companies have stopped making the medication. Previously there were the two formulations of gold shots, Solganol and Myochrysine. Only Myochrysine is now available and often patients develop a reaction to it, making discontinuation necessary.

Oral Gold Compared to Injectable Gold

Oral gold unfortunately had only minimal benefit in treatment so it was uncommonly prescribed. Ridaura is the oral gold preparation.

While it may still be available, it is rarely used in the U.S. Oral gold was shown to be moderately effective when compared to placebo. It was considered equally effective to Plaquenil (hydroxychloroquine) and methotrexate, but with greater potential for toxicity.

The Bottom Line

Gold is an older DMARD (disease-modifying anti-rheumatic drugs) which has, in nearly all cases, been replaced by newer DMARDs and biologic drugs. The use of gold currently is reserved for patients who do not respond to or cannot tolerate methotrexate, other older DMARDs (such as plaquenil and sulfasalazine), or TNF blockers.   


Major side effects of gold therapy. UoToDate. December 2015.

Rheumatoid Arthritis: Early Diagnosis and Treatment . Gold Salts. Third edition. Cush, Weinblatt, Kavanaugh. Professional Communications, Inc. 

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