Gold therapy involves the use of gold salts—an anti-inflammatory component of the metal. An early disease-modifying treatment for rheumatoid arthritis (RA) and other inflammatory diseases, it is sold as the oral prescription medication Ridaura (auranofin). It is not commonly used today.
Developed during the 1920s, gold therapy—a.k.a. aurotherapy or chrysotherapy—was the main treatment for RA prior to the introduction of methotrexate in the 1990s. However, it has harsh side effects—including liver toxicity, kidney damage, and bone marrow diseases—and is less effective than modern treatments.
This article discusses the therapeutic use of gold salts. It explores how gold therapy may help treat RA and other chronic conditions. It also explains the potential side effects and warnings of using gold salts.
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Gold Salts for Rheumatoid Arthritis
Gold therapy treats rheumatoid arthritis in both adults and children, though it is rarely prescribed today. In the mid-20th century, injectable gold salts were found to have clinically significant benefits in the short-term treatment of RA.
Gold salts are no longer available by injection. Ridaura (auranofin), an oral capsule, is available with a prescription. Studies show oral gold salts are as effective as Plaquenil (hydroxychloroquine) and methotrexate but with greater potential for toxicity.
While the exact mechanism of gold's anti-inflammatory effect is not fully understood, gold salts appear to stop cells from releasing chemicals that can harm tissues. Therefore, it is classified as a disease-modifying anti-rheumatic drug (DMARD).
Research shows gold salts are most effective when given in the early stages of arthritis. While it may offer benefits to anyone with active joint pain and swelling, it cannot reverse structural joint damage from RA.
Gold therapy is also not a quick solution for pain. It can take between three and six months to notice any benefits from gold therapy.
The American College of Rheumatology does not recommend gold therapy for the treatment of arthritis due to the potential for serious side effects. When used, it is mostly reserved for patients who do not respond to or cannot tolerate methotrexate, other DMARDs, or TNF blockers.
Other Uses of Gold Salts
In addition to RA, gold salts have been used to treat other inflammatory conditions, including:
- Bronchial asthma
- Juvenile rheumatoid arthritis
- Lupus erythematosus
- Pemphigus vulgaris
- Psoriatic arthritis
- Sjogren syndrome
However, there is limited evidence to support these uses of gold therapy. Ridaura is only approved for use in people with RA.
Side Effects
Gold salts can have serious side effects, including gold toxicity. Side effects can arise at any time during the course of treatment. Be sure to tell your healthcare provider about any new symptoms you experience while taking gold therapy.
Common
The most common side effect of Ridaura is upset stomach and diarrhea. Other common side effects are generally mild and include:
- Rashes
- Mouth sores
- Metallic taste
- Thinning of hair
- Weakness, dizziness, or fainting immediately after treatment
Long-term gold therapy may result in a bluish discoloration of the skin to occur that can be permanent.
Severe
Gold therapy can have severe side effects including:
- Kidney damage: One in 10 patients may experience mild proteinuria. Before each treatment, a urine test will be done to check for protein. If positive, you will need to do a 24-hour urine collection. Proteinuria that exceeds 500 milligrams (mg) in 24 hours is an indication that gold therapy should be stopped.
- Bone marrow damage: Though uncommon, some patients may develop aplastic anemia, granulocytopenia, or immune thrombocytopenia. These conditions are indications for ceasing gold therapy. Your healthcare provider will routinely test your blood to check for indicators of these concerns.
- Increased pain: Though rare, some people experience an increase in musculoskeletal pain that requires discontinuation of treatment.
- Liver damage: Though very rare, liver damage is an indication to stop treatment. Your healthcare provider will monitor your liver enzymes with routine blood work to watch for liver damage.
- Open oral sores: If open sores occur in the mouth or throat, gold therapy should be stopped until the eruption heals, then restarted at a lower dose of 10 mg to 15 mg weekly (for injections), titrating up to the full dose.
Liver Damage from Medication (Drug-Induced Liver Disease)
Dosage
Gold salts are currently only available by prescription in an oral formula. Ridaura (auranofin) comes in 3 mg capsules.
Riduara is taken on a regular schedule as prescribed by your healthcare provider, which varies by individual:
- Adults: The typical starting dose for Ridaura is 3 mg twice a day or 6 mg once a day. After six months, it may be increased to 3 mg three times a day.
- Children: Ridaura is not approved for use in children. However, some healthcare providers may prescribe it as an off-label use. Follow your provider's instructions as written on the prescription label.
Ridaura can be taken with or without food, although taking it after a meal or light snack may help reduce stomach upset.
If you miss a dose, take it as soon as you remember, then take any remaining doses for that day at evenly spaced intervals. Do not take a double dose to make up for a missed one.
If you have any questions, talk to your practitioner or pharmacist.
Injectable forms of gold salts—Myochrysine (aurothiomalate) and Solganal (aurothioglucose)—are no longer manufactured.
Warnings and Interactions
Gold therapy should not be taken alongside other DMARDs, biologics, or antimalarial drugs as harmful interactions may occur. These include, but are not limited to:
- Arava (leflunomide)
- Azulfidine (sulfasalazine)
- Chloroquine
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- Humira (adalimumab)
- Kineret (anakinra)
- Orencia (abatacept)
- Plaquenil (hydroxychloroquine)
- Remicade (infliximab)
- Rituxan (rituximab)
- Simponi (golimumab)
- Trexall (methotrexate)
Your healthcare provider may prescribe other types of RA medications, such as corticosteroids, analgesics, and non-steroidal anti-inflammatory drugs (NSAIDs), to ease symptoms while waiting for gold therapy to start working.
Do not drink alcohol while taking this medication. Discuss any prescription or over-the-counter drugs or supplements you are currently taking with your healthcare provider and pharmacist.
Summary
Gold salts are an anti-inflammatory agent historically used to treat rheumatoid arthritis and other autoimmune conditions. Developed a century ago, gold salts are considered an early disease-modifying anti-rheumatic drug.
Available by prescription as an oral drug, Ridaura is not widely used due to potentially harmful side effects, including gold toxicity. It was previously available as an intramuscular injection.
Ridaura is only approved for the treatment of RA in adults, though it may be prescribed off-label in children or for other uses. The most common side effect is an upset stomach, which may be relieved by taking it with food.
Do not drink alcohol while taking Ridaura, and do not take it alongside other DMARDs, biologics, or antimalarial drugs. If you experience side effects or have questions, talk to your healthcare provider.
What Is "Target to Treat" for RA?
10 Sources
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Johns Hopkins Arthritis Center. Rheumatoid Arthritis Treatment: Gold.
Balfourier A, Kolosnjaj-Tabi J, Luciani N, Carn F, Gazeau F. Gold-based therapy: From past to present.Proc Natl Acad Sci U S A. 2020;117(37):22639–48. doi:10.1073/pnas.2007285117
University of Washington Medicine. Gold treatment.
Joshi P, Dhaneshwar SS. An update on disease modifying antirheumatic drugs. Inflamm Allergy Drug Targets. 2014;13(4):249-61. doi: 10.2174/187152811304140915152102
National Institutes of Health: DailyMed. Prescribing information: Ridaura (Auranofin) capsules.
Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.Arthritis Rheumatol. 2016;68(1):1-26. doi:10.1002/art.39480
Corrigan CJ. Asthma refractory to glucocorticoids: the role of newer immunosuppressants. Am J Respir Med. 2002;1(1):47-54. doi:10.1007/BF03257162
Ruocco E, Wolf R, Ruocco V, Brunetti G, Romano F, Lo Schiavo A. Pemphigus: associations and management guidelines: facts and controversies.Clin Dermatol. 2013;31(4):382–90. doi:10.1016/j.clindermatol.2013.01.005
U.S. National Library of Medicine: MedlinePlus. Auranofin.
Mayo Clinic. Gold compound (oral route, parenteral route).
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By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.
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As an expert in the field of rheumatology and autoimmune diseases, my knowledge is grounded in extensive research, academic training, and practical experience. I hold a deep understanding of various therapeutic approaches, including traditional and modern treatments for conditions like rheumatoid arthritis (RA). My expertise extends to the historical development of treatments, their mechanisms of action, and the current landscape of rheumatologic care.
Now, let's delve into the concepts presented in the provided article on gold therapy for rheumatoid arthritis:
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Gold Therapy Overview:
- Gold therapy, also known as aurotherapy or chrysotherapy, involves the use of gold salts as an anti-inflammatory component.
- It was developed in the 1920s and served as a primary treatment for RA until the introduction of methotrexate in the 1990s.
- The main oral prescription medication for gold therapy is Ridaura (auranofin).
-
Effectiveness and Side Effects:
- Gold therapy has shown efficacy in treating RA, especially in the mid-20th century when injectable gold salts demonstrated short-term benefits.
- Harsh side effects include liver toxicity, kidney damage, and bone marrow diseases.
- It is considered less effective than modern treatments and may take three to six months to show benefits.
-
Mechanism of Action:
- The exact anti-inflammatory mechanism of gold salts is not fully understood, but they appear to inhibit cells from releasing harmful chemicals, classifying them as disease-modifying anti-rheumatic drugs (DMARDs).
-
Applicability and Recommendations:
- Gold therapy is not commonly prescribed today, and the American College of Rheumatology does not recommend it as a primary treatment for arthritis.
- It may be considered for patients who do not respond to or cannot tolerate other medications like methotrexate or TNF blockers.
-
Other Uses of Gold Salts:
- Gold salts have been used in treating conditions beyond RA, including bronchial asthma, juvenile rheumatoid arthritis, lupus erythematosus, pemphigus vulgaris, psoriatic arthritis, and Sjogren syndrome.
- However, evidence supporting these uses is limited, and Ridaura is approved only for RA.
-
Dosage and Administration:
- Ridaura (auranofin) is available in 3 mg capsules and is taken orally.
- Dosage varies for individuals, with a typical starting dose of 3 mg twice a day for adults.
- It can be taken with or without food, and missing a dose should not be compensated with a double dose.
-
Side Effects and Warnings:
- Common side effects include upset stomach, diarrhea, rashes, mouth sores, metallic taste, and long-term bluish discoloration of the skin.
- Severe side effects may include kidney damage, bone marrow damage, increased pain, liver damage, and open oral sores.
- Routine monitoring, including urine and blood tests, is essential.
-
Interactions and Contraindications:
- Gold therapy should not be taken alongside other DMARDs, biologics, or antimalarial drugs.
- Alcohol consumption is not recommended during gold therapy.
In conclusion, gold therapy is a historical but less frequently used approach in the management of RA, with potential serious side effects that warrant careful consideration by healthcare providers and patients.
