Gold tends to be an older therapy and it is not commonly prescribed any more. It may be given to patients who have not responded to other medications, or to patients who cannot take other medications.
Gold is administered as an intramuscular injection once a week, usually into a muscle in the buttocks or thigh. Injections are usually given by a doctor or nurse.
When starting gold, a small “test dose” of 10mg is usually given in the first week to make sure patients are not sensitive to it. A second injection is given a week later, building up to 25mg. If there were no issues with the first two injections, then a dose of 50mg is usually given every week. In patients who respond well to gold, it may be possible to reduce the frequency to every two to four weeks.
Gold does not work right away. It can take 3 months for patients to start feeling the effects of gold, and up to 12 months to start feeling the maximum effects.
Important Tests and Risks
Patients who take Gold need to get regular blood and urine tests to continually monitor for side effects. It is important to make sure the medicine is having no harmful effects on the kidneys, liver, or to blood counts. Tests are usually done every week. For some patients who are responding well and have not experienced any problems after a long time, the testing frequency may be reduced.
Severe reactions called nitritoid reactions can occur when Gold is given to patients who are taking ACE-inhibitors, a type of medicine used to treat hypertension. These reactions can include severe lowering of blood pressure, flushing, nausea, and fainting.
Because gold therapy is not often used and tends to be an older therapy, we have created a handy information pamphlet to help primary care physicians understand the side effects of gold and how to handle them: Gold Information for Administering Health Care Practitioners (PDF).
How Gold Works
Although Gold has been used to treat arthritis for a long time, the mechanism by which Gold helps arthritis is unknown.
Side Effects of Gold
Patients should talk to their doctor if they are concerned about any side effects.
It is important for patients taking Gold to get regular blood and urine tests as scheduled by their doctor.
MORE COMMON side-effects include:
- Skin Rash – Usually itchy, red, and scaly with tiny bumps. It can appear anywhere on the body. Generally it is mild and goes away on its own within a few weeks if the gold is stopped. A rash does not mean patients have to stop gold altogether. When the rash disappears, gold can be started at a lower dose.
- Sores in the mouth
- Metallic taste
- Some patients experience aching muscles or joints after an injection. Patients should let their doctor know if it is severe.
RARE side-effects include:
- Allergy-like Reaction – Some patients experience weakness, faintness, dizziness, or nausea after receiving the gold injection. This usually goes away after you lie down for a few minutes.
- Kidney irritation – This may not cause symptoms but may be found on blood and urine tests. It is uncommon and usually reversible when regularly monitored with your blood and urine tests.
- Blood Counts – Gold can cause a drop in the numbers of red blood cells (which carry oxygen), white blood cells (which are needed to fight infection) and platelets (which help to stop bleeding). Because doctors monitor the blood count very closely, it is unusual for this to be a serious problem.
- Liver, Intestine, and Lungs – There are rare reports of Gold damaging the liver, intestine or lungs. Fortunately, this is very rare.
How to minimize the side-effects of Gold:
- Patients should inform their doctor of any rashes, itchiness, or mouth sores prior to each injection
- Patients should get blood and urine tests done on-time, as scheduled by their doctor.
Who Should NOT Take Gold
Patients who should NOT be taking Gold include:
- Those who have had a previous serious reaction to Gold
- Some patients with diseases of the kidney or blood disorders
- Patients with systemic lupus erythematosus
- Possibly patients taking a type of medication called an ACE-inhibitor
Patients who become pregnant while taking Gold notify their doctor and discuss the risks and benefits of continuing therapy. It is usually recommended that Gold be stopped during pregnancy, although it has been safely used during pregnancy and by nursing mothers.
When to Call a Doctor
People taking Gold should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons to call a doctor while taking Gold include:
- Feeling weak, faint, dizzy, or sick after an injection
- Developing mouth sores
- Muscle aches or joint aches, especially if its bad
- Developing a rash or feeling itchy
Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Gold.