Gold-containing drugs are pharmaceuticals that contain gold. Sometimes these species are referred to as "gold salts". "Chrysotherapy" and "aurotherapy" are the applications of gold compounds to medicine. [1] Research on the medicinal effects of gold began in 1935, [2] primarily to reduce inflammation and to slow disease progression in patients with rheumatoid arthritis. 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.
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. [3]
The use of injected gold compound is indicated for rheumatoid arthritis. [4] Its uses have diminished with the advent of newer compounds such as methotrexate and because of numerous side effects. [4] The efficacy of orally administered gold is more limited than injecting the gold compounds. [5]
The mechanism by which gold drugs affect arthritis is unknown. [5]
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, indicating kidney damage, and blood tests are required.
A 1997 review (Suarez-Almazor ME, et al) [6] 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.
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. [7] 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. This condition is similar to argyria, which is caused by exposure to silver salts and colloidal silver. Chrysiasis can ultimately lead to acute kidney injury (such as tubular necrosis, nephrosis, glomerulitis), [8] severe heart conditions, and hematologic complications (leukopenia, anemia). [9] [10] [11] While some effects can be healed with moderate success, the skin discoloration is considered permanent.
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. [5]
Cortisone is a pregnene (21-carbon) steroid hormone. It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of the enzyme corticosteroid 11-beta-dehydrogenase isozyme 2 into the inactive metabolite cortisone, particularly in the kidneys. Cortisone is converted back to the active steroid cortisol by the action of the enzyme 11β-Hydroxysteroid dehydrogenase type 1, particularly in the liver.
Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent activity of the immune system.
Methotrexate (MTX), formerly known as amethopterin, is a chemotherapy agent and immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. Types of cancers it is used for include breast cancer, leukemia, lung cancer, lymphoma, gestational trophoblastic disease, and osteosarcoma. Types of autoimmune diseases it is used for include psoriasis, rheumatoid arthritis, and Crohn's disease. It can be given by mouth or by injection.
Disease-modifying antirheumatic drugs (DMARDs) comprise a category of otherwise unrelated disease-modifying drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroidal anti-inflammatory drugs and steroids.
Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. This often happens in association with changes to the nails such as small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin changes consistent with psoriasis frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy.
Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthritis, dermatitis, eye inflammation, asthma, and multiple sclerosis. It can be taken by mouth, injected into a vein, used topically as a skin cream, or as eye drops.
An injection is the act of administering a liquid, especially a drug, into a person's body using a needle and a syringe. An injection is considered a form of parenteral drug administration; it does not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections.
Pyritinol also called pyridoxine disulfide or pyrithioxine (European drug names Encephabol, Encefabol, Cerbon 6) is a semi-synthetic water-soluble analog of vitamin B6 (Pyridoxine HCl). It was produced in 1961 by Merck Laboratories by bonding 2 vitamin B6 compounds (pyridoxine) together with a disulfide bridge. Since the 1970s, it has been a prescription and OTC drug in several countries for cognitive disorders, rheumatoid arthritis, and learning disorders in children. Since the early 1990s it has been sold as a nootropic dietary supplement in the United States.
Methylprednisolone is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used concomitantly at high doses during acute flares. Methylprednisolone and its derivatives can be administered orally or parenterally.
Chrysiasis is a dermatological condition induced by the parenteral administration of gold salts, usually for the treatment of rheumatoid arthritis. Such treatment has been superseded as the best practice for treating the disease because of "numerous side effects and monitoring requirements, their limited efficacy, and very slow onset of action".
Disodium aurothiomalate is a chemical compound with the formula AuSCH(CO2Na)CH2CO2Na. In conjunction with its monoprotonated derivative, this coordination complex or closely related species are used to treat rheumatoid arthritis, under the tradename Myochrysine. The thiomalate is racemic in most formulation.
Felty's syndrome (FS), also called Felty syndrome, is rare autoimmune disease characterized by the triad of rheumatoid arthritis, enlargement of the spleen and low neutrophil count. The condition is more common in those aged 50–70 years, specifically more prevalent in females than males, and more so in Caucasians than those of African descent. It is a deforming disease that causes many complications for the individual.
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.
Auranofin is a gold salt classified by the World Health Organization as an antirheumatic agent. It has the brand name Ridaura.
Sodium aurothiomalate 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 compounds currently employed in modern medicine.
Jacques Forestier was a French internist who was a pioneer in the field of rheumatology.
Tolmetin is a nonsteroidal anti-inflammatory drug (NSAID) of the heterocyclic acetic acid derivative class. It is used primarily to reduce hormones that cause pain, swelling, tenderness, and stiffness in conditions such as osteoarthritis and rheumatoid arthritis, including juvenile rheumatoid arthritis. In the United States it is marketed as Tolectin and comes as a tablet or capsule.
A metallopharmaceutical is a drug that contains a metal as an active ingredient. Most commonly metallopharmaceuticals are used as anticancer or antimicrobial agents. The efficiency of metallopharmaceuticals is crucially dependent on the respective trace metal binding forms.
Insects have long been used in medicine, both traditional and modern, sometimes with little evidence of their effectiveness. For the purpose of the article, and in line with custom, medicinal uses of other arthropods such as spiders are included.
An antiarthritic is any member of the group of drugs used to relieve or prevent arthritic symptoms, such as joint pain and joint stiffness. Depending on the antiarthritic drug class, it can be responsible for managing pain, reducing inflammation and/or acting as an immunosuppressant. These drugs are typically given orally, topically or through administration by injection. The choice of antiarthritic medication is often determined by the type/nature of arthritis, the severity of symptoms as well as other factors, such as the tolerability of side effects.
adverse effects including allergy to gold, tolerance to gold decreasing with age, skin and renal complications.