Gold therapy adverse effects

Adverse side effects of gold treatments include stomatitis, rash, and proteinuria. Complete blood counts and urinalysis should be performed before each or every other injection of gold compounds. Pmritic skin rash and stomatitis are more common adverse effects that may resolve, if therapy is withheld for a few weeks and then restarted cautiously at a lower dose. Oral gold causes less mucocutaneous, bone marrow, and renal toxicity than injectable gold, but more diarrhea and other gastrointestinal reactions appear. 

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

Generally, 2 months of multiple dosing of gold compounds is required to reach steady-state levels. Auranofm therapy produces lower steady-state blood gold concentrations than does treatment with parenteral gold compounds, but it also produces a lower incidence of adverse effects. 

Bone marrow aplasia, history of gold-induced pathologies, including blood dyscra-sias, exfoliative dermatitis, necrotizing enterocolitis, and pulmonary fibrosis, serious adverse effects with previous gold therapy, severe blood dyscrasias... 

Adverse Side Effects. Adverse effects are relatively common with gold therapy, with approximately one third of patients experiencing some form of toxic effect.84 The primary side effects caused by gold compounds are gastrointestinal distress (diarrhea, indigestion), irritation of the oral mucosa, and rashes and... 

The most common adverse effects of auranofin are gastrointestinal. About half of all users have loose stools at some time during treatment this effect can be transient, can occur at any time, and is rarely severe. No infective cause or signs of malabsorption has been found in any case and neither was gold absorption adversely affected. In a long-term study, diarrhea was mainly observed in the first 6 months of therapy with auranofin 6 mg/day in 8% of the cases this was a reason for withdrawal (44). There is experimental evidence in animals of a direct effect of auranofin on ion and water absorption from the intestine with inhibition of enterocjde Na+/K+-ATPase activity (SED-12, 525). 

Kean WF, Lock CJL, Floward-Lock FIE, Buchanan WW. Prior gold therapy does not influence the adverse effects of D-penicillamine in rheumatoid arthritis. Arthritis Rheum 1982 25 917-922. 

Gold drugs, such as aurothioglucose, gold sodium thiomalate, and auranofin, have long been used in the treatment of rheumatoid arthritis. The most common adverse effects associated with gold therapy appeared in skin and mucous membranes (about 15% of all patients) and kidneys (about 5-10%), mostly as proteinuria. 

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