Rheumatoid arthritis gold salts

Metals A wide range of metals induce nephrotoxicity in humans and/or in animal models (Table 5). Some of these metals (e.g., iron, cobalt, copper) are essential elements required for normal body function, while others can be useful in treating diseases. For example, gold salts are useful in treating rheumatoid arthritis lithium salts are indicated for the treatment of manic-depressive illness and aluminum and bismuth salts are available to treat indigestion and stomach aches. However, exposure to these and other metals can occur from environmental sources and in excessive concentrations, can lead to nephropathy. 

The purpose of this volume is to survey the pharmacological uses of transition metal complexes and demonstrate the wide variety and applicability of these systems. Pharmacology in this sense includes aspects of both chemotherapy and pharmacodynamics [1], Main group complexes will not be reviewed but much information on these systems is contained in the volume Organometallic Compounds and Living Organisms [2]. The use of platinum salts in cancer, gold salts in rheumatoid arthritis, silver salts as topical antibacterials, and a simple iron complex in heart disease is witness to this diversity. 

Gold salts have had a long history of use in rheumatoid arthritis.269,270 The development of orally active auranofin (also known as Ridaura (50), Figure 23) was a major improvement over the early injectable gold preparations which were polymeric (e.g., (51)—(53)). However, use has declined with the popularity of nonsteroidal antiinflammatory drugs (NSAIDS) such as indo-methacin a recent estimate of the commercial value for auranofin was 6 million. The mechanism... 

Two forms of gold provide medical treatments. The radioactive isotope Au-198, with a short half-life of 2.7 days, is used to treat cancer and is produced by subjecting pure gold to neutrons within a nuclear reactor. A gold salt, a solution called sodium thiosulfate (AuNa O Cl ), is injected as an internal treatment for rheumatoid arthritis. However, since gold and some of its compounds are toxic when ingested, this treatment may cause complications such as skin rashes and kidney failure. It is a less popular treatment, particularly with the development of newer and more effective medications. 

Gold salts have been used for the treatment of rheumatoid arthritis for more than 40 years. Despite their proved efficacy in a large proportion... 

Therapeutic uses The major use of gold salts is in the treatment of rheumatoid arthritis that does not respond to salicylates or... 

Correct answer - C. Gold salts may not provide clinical improvement until after several weeks of administration. They are thought to suppress phagocytosis and lysosomal enzyme activity in macrophages. Gold salts are used in rheumatoid arthritis that does not respond to NSAIDs. Auranofin can be taken by mouth. 

Both parenteral and oral gold salts are used in the treatment of rheumatoid arthritis. After prolonged administration, gold can be deposited in various tissues of the body, a condition known as chrysiasis. 

Gold salts (parenteral, oral) (rheumatoid arthritis)... 

Thiomalate (salt of ester of the malic acid) also has been used very successfully to treat severe cases of rheumatoid arthritis. A complete cure or a significant improvement has been noted in approximately 50% of patients using this treatment modality, with 40% of patients exhibiting side effects. Thiomalate is also toxic and possesses cumulative action. Minimal concentrations of the gold compounds reach many cells and remain in the body for years. ... 

In rheumatoid arthritis the most commonly used gold salts are sodium aurothiomalate and aurothioglucose (3). There is some reason to believe that adverse effects are less frequent with the suspensions (of aurothioglucose or aurothiosulfate) than with the more rapidly absorbed solution (of sodium gold thiomalate) (SEDA-16, 233) (4). 

Van Linthoudt D, Buss W, Beyner F, Ott H. Necrose hepatique fatale au cours d un traitement aux sels d or d une polyarthrite rheumatoide. [Fatal hepatic necrosis due to a treatment course of rheumatoid arthritis with gold salts.] Schweiz Med Wochenschr 1991 121(30) 1099-102. 

Ciompi ML, Marchetti G, Bazzichi L, Puccetti L, AgeUi M. D-penicillamine and gold salt treatments were comphcated by myasthenia and pemphigus, respectively, in the same patient with rheumatoid arthritis. Rheumatol Int 1995 15(3) 95-7. 

Hakala M, van Assendeht AH, Ilonen J, Jalava S, Tiilikainen A. Association of different HLA antigens with various toxic effects of gold salts in rheumatoid arthritis. Ann Rheum Dis 1986 45(3) 177-82. 

A chemical may adhere to a native protein to produce an antigen and ehcit an antibody response. For example, colloidal gold and gold salts, which are used to treat rheumatoid arthritis, induce membranous nephropathy with numerous electron-dense deposits... 

Eurst DE, Levine S, Srinivasan R, Metzger L, Bangert R, Paulus E. A double-blind trial of high versus conventional dosages of gold salts for rheumatoid arthritis. Arthritis Rheum 1977 20 1473-1480. 

Skirfvars B, Tornroth T, Flaick HM. Granulomatous glomerulonephritis in a patient with rheumatoid arthritis treated with gold salts. Scand J Rheumatol 1979 8 234-240. 

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. 

Lymphadenopathy may occur in patients with rheumatoid arthritis, particularly in nodes proximal to more actively involved joints. Renal involvement is rare but can be associated with treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs), gold salts, and penicillamine. Amyloidosis is a rare complication of long-standing rheumatoid arthritis. It appears to be more common in Europe than in the United States. 

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. 

---