Gold in rheumatoid arthritis

When using gold in RA, the following should be noted:

• therapeutic effects of gold salts develop slowly - maximum response is reached after 4-6 months treatment
  
  
• i.m. gold:
  • a 10mg test dose is first given - this is necessary to exclude hypersensitivity
  • test dose followed by 50mg i.m. weekly until response occurs
  • change in dosage interval is undertaken 3-monthly because of lead-time in clinical response to change in dose
  • if no response after 1000mg total dose then treatment should be discontinued
  • if response to gold i.m. then:
    • monthly doses while arthritis persists
    • maintain for 5 years after complete remission
      
      
• oral gold:
  • dose:
    • initial 3mg/daily for 4 weeks
    • maintenance 3mg bd
    • if no response to can be increased to 3mg tds
      
      
• oral preparation has fewer side effects than i.m.
• most common side effect is diarrhoea