INJECTABLE GOLD COMPOUNDS: AN OVERVIEW

SUMMARY Injectable gold compounds have enjoyed widespread, but occasionally controversial, use in rheumatoid arthritis since the 1920s. This overview examines the data from controlled trials and longer-term observational studies. We conclude that gold is equivalent to other widely used second-line agents in terms of efficacy. Toxicity profiles are similar, apart from methotrexate. It is most efficacious and toxic in the first 2 yr of treatment. There appears to be a dose-response relationship for both efficacy and toxicity. Gold is one of the few agents that decreases the rate of progression of erosions (RR 0.38, 95% CI 0.23-0.64). Gold compounds, therefore, have a definite place in the rheumatologist's armamentarium, but further research is required to determine optimal monitoring regimes as well as the role of maintenance therapy and combination therapy. INJECTABLE gold compounds have been used for the treatment of chronic arthritis since the early 1920s. Forestier (1) was one of a substantial number of early investigators who published virtually simultaneously on the therapeutic benefits of gold. He studied gold complexed with thiopropanolsulphonate (Allo- chrysine) in 550 subjects. He concluded that it was beneficial for rheumatoid arthritis (RA; early or late), Still's disease, metastatic arthritis (probably Reiter's syndrome), some forms of tuberculous arthritis and ankylosing spondylitis. He also stated, without being specific, that monitoring for toxicity should be done at frequent intervals. The use of gold compounds remains controversial to this day with much disagreement in the literature, but some of Forestier's conclusions have stood the test of time even though injectable gold complexes have been subject to more rigorous and detailed scientific scrutiny than perhaps any other therapeutic agent in rheumatology. In this review, we would like to discuss the controlled trial evidence relating to gold efficacy and toxicity, including the data from meta-analyses and longer-term observational studies.