Introduction
An inflammatory condition known as rheumatoid arthritis (RA) causes inflammation in the joints, which causes pain, stiffness, and swelling. It has a huge influence on millions of people's quality of life and impacts them on a global scale. Various forms of therapy have been investigated throughout the years to control the disease's symptoms and delay its course.
Gold therapy is a type of treatment. For many years, individuals with progressing rheumatoid arthritis have been treated mostly with gold. Two gold therapy types are available, one intravenously and the other orally. Treatment with one of these substances will be clinically beneficial for some patients.
What Is the Mechanism of Action of Gold Therapy in Rheumatoid Arthritis?
Gold salts are given to rheumatoid arthritis sufferers as part of gold therapy, sometimes called chrysotherapy. Numerous possibilities have been put forward, even though the exact mechanism of action has yet to be entirely established. Lysosomal enzymes and protein kinase C are two examples of inflammatory enzymes that gold compounds are considered to inhibit. These enzymes significantly influence the breakdown of joint tissues and the creation of inflammatory mediators. Gold treatment reduces inflammation and joint damage in rheumatoid arthritis by obstructing their activity.
What Is the Efficacy of Gold Therapy?
Over the years, there has been much discussion and investigation over the efficacy of gold therapy in treating rheumatoid arthritis. Early research done in the 20th century suggested that gold compounds, like auranofin and gold sodium thiomalate, could help rheumatoid arthritis patients feel better and reduce the progression of their disease.
However, the use of gold compounds has decreased due to the development of more modern and focused treatments. However, some people continue to benefit from gold therapy, particularly when other therapies have been ineffective or are not recommended.
What Are the Uses of Gold Therapy in Rheumatoid Arthritis?
For many years, rheumatoid arthritis has been treated with gold therapy. There are still some circumstances where gold therapy may be explored, even if its use has decreased due to the development of newer, more specialized treatments.
The following are a few applications for gold therapy in rheumatoid arthritis:
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Disease Modification: In patients with rheumatoid arthritis, gold therapy, notably with gold sodium thiomalate or auranofin, has been demonstrated to have disease-modifying effects. It can protect joint function and help halt the course of joint deterioration. Gold therapy can change the course of the disease by lowering inflammation and blocking enzymes responsible for joint deterioration.
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Treatment Failure: Patients who have not responded well enough to other disease-modifying antirheumatic medications (DMARDs) or who have experienced excessive side effects from other treatments may be candidates for gold therapy. Gold therapy may provide a different option to control symptoms and enhance disease management.
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Combination Therapy: To improve the therapeutic response, gold therapy may be combined with other DMARDs, such as Methotrexate or Sulfasalazine. It may have beneficial synergistic effects and enhance overall illness control by combining gold therapy with other medications. Individuals with moderate to severe rheumatoid arthritis who need a more intensive treatment plan frequently use this method.
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Patient Preference: In some cases, individuals may prefer gold therapy because of pleasant experiences in the past or because they want to stay away from newer, perhaps more expensive drugs. Considerations like patient desire and input into treatment choices are crucial, and if a patient displays a preference for gold therapy, it is likely a feasible option.
It is crucial to remember that gold therapy is typically only done in certain circumstances and is not regarded as a first-line option for treating rheumatoid arthritis.
How Is Gold Therapy Given to Patients?
The only kind of gold therapy now offered is oral. Due to a global shortage of gold sodium thiomalate, intramuscular gold production was stopped in 2019.
Dosage
As directed by the healthcare professional, Ridaura, an oral gold treatment, is administered as a capsule taken regularly.
Usually, the dosage is:
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Adults: For adults, take six milligrams once daily or three milligrams twice daily. Three times a day at a dose of three milligrams is possible after six months.
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Children: The healthcare professional who is prescribing will establish the appropriate dose.
The dosage is quite personalized. Follow the directions on the prescription label given to the individual by their doctor exactly. Consult the physician or pharmacist if they have any queries. If one needs to remember to take a dose, do it as soon as they remember. Then, space out the remaining doses throughout the day. Take advantage of a second dose to make up for a missed dose. Although it may take up to six months to reap the full rewards of this treatment, it typically takes three to four months to observe improvements from gold therapy.
What Are the Side-Effects of Gold Therapy in Rheumatoid Arthritis?
Gold therapy involves many side effects; one may not need to discontinue taking the prescription. However, some side effects can be severe, persistent, and, in rare circumstances, even fatal.
The most typical side effects are as follows:
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Body rashes.
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Oral ulcers.
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Dysgeusia (a metallic aftertaste in the mouth)
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Nausea
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Stomach problems such as diarrhea.
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Fever.
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A feeling of unsteadiness or syncope.
Other side effects consist of:
Digestive Problems: Gut damage (Enterocolitis)
Renal Problems: Inflammation (nephritis), protein in the urine (proteinuria), and kidney failure.
Hematological Issues: Aplastic anemia, thrombocytopenia, low platelet count, hypereosinophilia, and neutropenia are all problems with the bone marrow.
Respiratory Problems: Interstitial fibrosis and bronchitis are respiratory conditions.
Cardiovascular Problems: Heart attacks, strokes.
Symptoms of the Nervous System:
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Polyneuritis is an inflammation of the peripheral nerves.
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Alterations in the brain (encephalopathy).
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Morvan syndrome.
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Guillain-Barré syndrome.
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Meningitis.
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Hepatic problems like jaundice and cholestatic hepatitis.
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A blue or gray darkening of the skin and/or a golden ring around the eye's cornea are examples of potentially permanent side effects.
Who Should Not Have Gold Therapy?
Gold treatment should not be advocated for the following patients:
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Chronic renal disease.
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Serious hepatitis disorders.
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Pregnant or lactating women should not be administered Ridaura. It is advised to wait six months after quitting the drug before trying to get pregnant because it takes time for the gold to leave the body.
Additionally, one should not receive gold therapy if they are allergic to gold or have experienced a negative reaction to gold therapy in the past.
Conclusion
Despite its decreasing popularity, gold therapy can still manage rheumatoid arthritis in some circumstances. Gold compounds have been demonstrated to minimize inflammation and relieve symptoms in some individuals, but their specific mechanism of action has yet to be discovered. The medication may have side effects ranging from minor and reversible to serious and life-threatening. As a result, when thinking about gold therapy, proper patient selection and constant monitoring are crucial.
