Gold-containing drugs are

pharmaceutical A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field an ...

s that contain

gold Gold is a chemical element with the symbol Au (from la, aurum) and atomic number 79. This makes it one of the higher atomic number elements that occur naturally. It is a bright, slightly orange-yellow, dense, soft, malleable, and ductile me ...

. Sometimes these species are referred to as "gold salts". "Chrysotherapy" and "aurotherapy" are the applications of gold compounds to medicine. Research on the medicinal effects of gold began in 1935, primarily to reduce

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

and to slow

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

progression in patients with

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are invol ...

. The use of gold compounds has decreased since the 1980s because of numerous side effects and monitoring requirements, limited efficacy, and very slow onset of action. Most chemical compounds of gold, including some of the drugs discussed below, are not salts, but are examples of metal thiolate complexes.

Use in rheumatoid arthritis

Investigation of medical applications of gold began at the end of the 19th century, when gold cyanide demonstrated efficacy in treating '' Mycobacterium tuberculosis'' in vitro.

Indications

The use of injected gold compound is indicated for rheumatoid arthritis. Its uses have diminished with the advent of newer compounds such as methotrexate and because of numerous side effects. The efficacy of orally administered gold is more limited than injecting the gold compounds.

Mechanism in arthritis

The mechanism by which gold drugs affect arthritis is unknown.

Administration

Gold-containing drugs for rheumatoid arthritis are administered by intramuscular injection but can also be administered orally (although the efficacy is low). Regular urine tests to check for

protein Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residues. Proteins perform a vast array of functions within organisms, including catalysing metabolic reactions, DNA replication, res ...

, indicating

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...

damage, and blood tests are required.

Efficacy

A 1997 review (Suarez-Almazor ME et al.) reports that treatment with intramuscular gold (parenteral gold) reduces disease activity and joint inflammation. Gold-containing drugs taken by mouth are less effective than by injection. Three to six months are often required before gold treatment noticeably improves symptoms.

Side effects

Chrysiasis

A noticeable side-effect of gold-based therapy is skin discoloration, in shades of mauve to a purplish dark grey when exposed to sunlight. Skin discoloration occurs when gold salts are taken on a regular basis over a long period of time. Excessive intake of gold salts while undergoing chrysotherapy results – through complex redox processes – in the saturation by relatively stable gold compounds of skin tissue and organs (as well as teeth and ocular tissue in extreme cases) in a condition known as

chrysiasis Chrysiasis is a dermatological condition induced by the parenteral administration of gold salts, usually for the treatment of rheumatoid arthritis.James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Derma ...

. This condition is similar to

argyria Argyria or argyrosis is a condition caused by excessive exposure to chemical compounds of the element silver, or to silver dust. The most dramatic symptom of argyria is that the skin turns blue or blue-grey. It may take the form of ''generalize ...

, which is caused by exposure to silver salts and colloidal silver.

Chrysiasis Chrysiasis is a dermatological condition induced by the parenteral administration of gold salts, usually for the treatment of rheumatoid arthritis.James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Derma ...

can ultimately lead to

acute kidney injury Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both. Causes of AKI are c ...

(such as tubular necrosis, nephrosis, glomerulitis), severe heart conditions, and hematologic complications (leukopenia, anemia). While some effects can be healed with moderate success, the skin discoloration is considered permanent.

Other side effects

Other side effects of gold-containing drugs include kidney damage, itching rash, and ulcerations of the mouth, tongue, and pharynx. Approximately 35% of patients discontinue the use of gold salts because of these side effects. Kidney function must be monitored continuously while taking gold compounds.

Types

Disodium aurothiomalate Disodium aurothiomalate is a chemical compound with the formula AuSCH(CO2Na)CH2CO2Na. In conjunction with its mono protonated derivative, this coordination complex or closely related species are used to treat rheumatoid arthritis, under the trade ...

Sodium aurothiosulfate Sodium aurothiosulfate, or sanocrysin, is the inorganic compound with the formula . This salt contains an anionic coordination complex of gold(I) bound to two thiosulfate ligands. It is colorless. History The compound was first synthesized in 18 ...

(Gold sodium

thiosulfate Thiosulfate ( IUPAC-recommended spelling; sometimes thiosulphate in British English) is an oxyanion of sulfur with the chemical formula . Thiosulfate also refers to the compounds containing this anion, which are the salts of thiosulfuric acid, ...

) *

Sodium aurothiomalate Sodium aurothiomalate ( INN, known in the United States as gold sodium thiomalate) is a gold compound that is used for its immunosuppressive anti-rheumatic effects. Along with an orally-administered gold salt, auranofin, it is one of only two ...

(Gold sodium

thiomalate A thiomalic acid or mercaptosuccinic acid is a dicarboxylic acid containing a thiol functional group. As suggested by its name, it contains a thiol group (SH) in place of the hydroxy group (OH) in malic acid. Salts and esters are known as thioma ...

) (UK) *

Auranofin Auranofin is a gold salt classified by the World Health Organization as an antirheumatic agent. It has the brand name Ridaura. Use Auranofin is used to treat rheumatoid arthritis. It improves arthritis symptoms including painful or tender and ...

(UK & US) *

Aurothioglucose Aurothioglucose, also known as gold thioglucose, is a chemical compound with the formula AuSC6H11O5. This derivative of the sugar glucose was formerly used to treat rheumatoid arthritis. History Throughout history, gold was used to cure diseases ...

(Gold thioglucose) (US)

References

External links

Gold salts for juvenile rheumatoid arthritis
. BCHealthGuide.org

. DiseasesDatabase.com

Sheds light on how medicinal metal function against rheumatoid arthritis and other autoimmune diseases." ''Harvard University Gazette'' (2006)

. MedicineNet.com

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

University of Washington The University of Washington (UW, simply Washington, or informally U-Dub) is a public research university in Seattle, Washington. Founded in 1861, Washington is one of the oldest universities on the West Coast; it was established in Seattl ...

(December 30, 2004) {{Antirheumatic products Gold compounds Hepatotoxins Antirheumatic products Coordination complexes Nephrotoxins