Rheumatoid arthritis gold salt therapy

Gold salts (sodium aurothiomalate) used in the treatment of rheumatoid arthritis have produced pulmonary fibrosis with cough, dyspnea, and pleuritic pain 5 to 16 weeks following institution of therapy. Pulmonary function tests show a restrictive defect, and patients generally have an eosinophilia. The reactions improve on discontinuation of the gold therapy and recur promptly on reexposure. The pulmonary deficit may not resolve completely. 

Thrombocytosis is another common hematologic finding with active rheumatoid arthritis. Platelet counts rise and fall in direct correlation with disease activity in many patients. Thrombocytopenia may result from toxicity of gold salts, penicillamine, or immunosuppressive therapy. Thrombocytopenia also may be observed in Felty s syndrome or vascuhtis. 

The decline in the number of reports of parenter-ally administered gold-induced nephropathy may indicate that the dose of gold salts used per injection is decreased and intervals between injections are being extended to prevent adverse reactions. Furthermore, introduction of methotrexate therapy for rheumatoid arthritis has contributed to decreased reliance on gold salts. 

Auranofin, a gold salt currently used for therapy of chronic inflammation associated with rheumatoid arthritis, has been reported to induce several stress proteins and inhibit interleukin synthesis in human peripheral blood monocytes (Caltabiano et al. 1986b Schmidt and Abdulla 1988). 

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