Forty-seven years experience with gold therapy in 1,019 rheumatoid arthritis patients

Abstract

T HIS REVIEW was derived from a survey of 7,750 patient records from 1933 to 1979. Much of the data concerns a special group of 1,019 patients with rheumatoid arthritis (RA) treated with gold salts, many of whom have been referred to in previous publications.’ ” The 1,019 patients with classical or dehnite RA according to the American Rheumatism Association criteria’ were treated with disodium (thiomalate-S) aurate (I) (Myochrysine Merck Sharp & Dohme, West Point, Pa) and followed prospectively. Of this group 3 I7 were men and 702 were women (median ages 46 and 47 years, respectively). Their age at onset of RA is detailed in Table I. The decision to start Myochrysine was based on the progression 01 active RA unresponsive to therapy with aspirin. later phenylbutazone and indomcthacin. and then by newer nonsteroidal antiinflammatory drugs and agents. Myochrysine was given initially as a IO-mg test dose, followed by :I 25-rng test dose one week later. If no adverse reaction occurred, then weekly injections of 40 mg intramuscularly (IM) were administered until at least 800 mg had been given. Then maintenance therapy of 40 mg IM was given ever!’ two to four weeks. The same dosage schedule was followed throughout the course. Efficacy was monitored by moditication similar to the assessment of functional class and radiographic staging after the criteria of Steinbrocker et al.” Considering that some of these patients predated this criteria. all were reviewed for the sake of consistency. None of the patients ToxIcit! ML{ monItored using clc)‘rc mouitilr ing \\btem \lmil:lr to that recentI de\crlbcti Skin toxicit! \\:I :in! event of ~~thcrMi\~ unc~ plained skin ra\h. dermatitis. ;ind/or ItchIn? Buccal irritation W;I~ ;In> Llphthous-like u/ccr II> the mouth. or :tn burning sensaticjrt of the bucc,li mcmbranc\. Ren;tl toxicit! consisted 01 the prc“cncc of hcmaturl;i. red cell and/cx an h!alinc GlSl\. ;L hell ;I t hc prcscnce 01 protein 3 n 1 hc urine ;i> mea\urcd b! x~lvcyl-sulphonic acid IC\I arid/c>>> dipstick 1.o~ platelet count v.;I~ a~cs~d