Gold Therapy

1. Indications (Replaced by Methotrexate)
   1. Rheumatoid Arthritis
   2. Seropositive Rheumatoid Arthritis
2. Efficacy (replaced by Methotrexate)
   1. Response rate
      1. Injection: 75%
      2. Oral: 50-60%
   2. Slowest therapeutic response of DMARD (3-6 months)
3. Adverse Effects
   1. Gold Injection
      1. Pruritic rash (20%)
      2. Stomatitis
      3. Proteinuria due to membranous nephritis (5%)
      4. Hematologic (1%)
         1. Leukopenia (more common)
         2. Thrombocytopenia
         3. Anemia (less common)
      5. Gold Pneumonitis (rare)
      6. Gold colitis (rare)
      7. Nitritoid Reaction (uncommon)
         1. Flushing and vasodilation
         2. Hypotension and Tachycardia
         3. Occurs 5-30 minutes after Gold Injection
   2. Oral Gold
      1. Diarrhea (common and may limit compliance)
      2. Dermatitis (less common than with injection)
4. Monitoring
   1. Indications to hold Gold Therapy
      1. Urinalysis with >2+ Proteinuria
      2. Complete Blood Count with cell line depression
         1. Leukopenia
         2. Thrombocytopenia
         3. Anemia
   2. Gold Injection
      1. Urinalysis for Proteinuria
         1. Obtain with each injection
      2. Complete Blood Count (CBC)
         1. Obtain weekly with each injection for 8 weeks
         2. Obtain monthly while on weekly injections
         3. Obtain every 3 months while on monthly gold
   3. Oral Injection
      1. Complete Blood Count (CBC) every 3 months
      2. Urinalysis for Proteinuria every 3 months
5. Dose
   1. Oral: 3 mg PO bid