Gold treatments were one of the earliest treatments for rheumatoid arthritis, going back at least 75 years. In 1985, methotrexate replaced gold injections as the first-line treatment for RA.
There is no cure for rheumatoid arthritis (RA). Medications can slow down the disease, while complementary therapies can help people cope with joint pain and stiffness, chronic fatigue, and other symptoms, such as low-grade fevers and dry skin and eyes.
While both gold injections were once praised for their high rates of remission, they are no longer made in the United States. This is due to potentially severe side effects and the development of stronger and better-tolerated RA medications.
This article discusses the history of using gold injections to treat RA and how the drug methotrexate came to replace it as the standard treatment in combination with biologic medications.
Gold injections were made from a compound called sodium aurothiomalate, which contains gold. Sodium aurothiomalate belongs to a class of drugs called disease-modifying antirheumatic drugs (DMARDs).
DMARDs are known for their inflammation-blocking qualities. If inflammation in the body is not blocked, this can cause the joints and tissues to wear down to the point of disability in just a few years.
These injections are not pain relievers. However, they do decrease pain because they decrease inflammation. They may also help manage morning joint stiffness and swelling associated with RA.
However, like other DMARDs, gold injections reduced the immune system’s response. As they suppressed the immune system to stop inflammation, they also increased the risk of infection.
Therefore, it was important for people to take care to avoid infections, get treated quickly for symptoms of a possible infection, and discuss the use of any live vaccines with their doctors.
Examples of live vaccines include:
- the nasal spray flu vaccine
- vaccine injections for varicella (chickenpox)
- the MMR vaccine (measles, mumps, and rubella)
Gold injections had long been used to treat RA and other inflammatory joint diseases. They had previously been proven successful for many people with RA.
Gold treatment was once the norm for treating moderate to severe RA. Its use goes back to the 1920s when gold compounds were treatments for tuberculosis.
Researchers once thought that RA and tuberculosis were related. Eventually, that theory was debunked, and the idea that gold could treat RA and provide significant symptom relief was confirmed.
The anti-inflammatory properties of gold compounds are unknown. However, there has been enough evidence to confirm that gold can inhibit the behavior of substances responsible for the production of antibodies and the release of inflammatory cytokines.
How was treatment given?
Gold injections were injected into a muscle, usually the buttock, by a medical professional. Individuals needed to lie down during injection and wait for a few minutes before sitting up or standing to avoid lightheadedness.
The dosage depended on the person’s medical condition, the severity of symptoms, and their response to treatment. Injections were given once a week until there was an improvement.
After that, they were given twice a month or less. If RA symptoms returned or worsened, then an individual went back to having the injections weekly.
Gold injection treatment needed to be used regularly for the best results. It could take up to 4–6 months before people saw significant results.
Due to the number and severity of side effects that they cause, doctors no longer use gold treatments to treat RA or other inflammatory conditions in the U.S. Doctors are prescribing other DMARDs instead, including methotrexate, which is considered safer.
Gold injections can cause side effects, including:
- nausea and vomiting
- flushing and sweating
- increased joint pain at the start of treatment
- kidney disease
More serious side effects could include any of the following:
- eye pain
- mood or mental state changes, such as confusion or hallucinations
- difficulty breathing
- stomach pain
- skin rash or another allergic reaction
- lower leg edema
The drug methotrexate has been used since the 1940s as a cancer treatment. Following a
Previous research has shown methotrexate to be just as effective as gold injections, according to a historical report of RA treatments.
Methotrexate may be one of the safest RA drugs. However, it can still
Some people, especially pregnant people, should not take methotrexate. A person should always discuss the use of the drug with a doctor to weigh up the risks and benefits.
If methotrexate does not provide adequate symptom relief on its own, doctors may prescribe it in combination with other medications such as biologic drugs. Options also include other DMARDs, such as sulfasalazine doxycycline and hydroxychloroquine.
Some researchers are looking to reintroduce gold as a treatment for RA. Newer studies on gold compounds are looking at better ways to manage the inflammatory process using gold with acceptable side effects, in particular in the form of nanoparticle therapy.
Researchers also want to take advantage of gold treatments for their antibacterial and antiviral properties. Moreover, the future use of
However, more research is needed to understand how to use gold in alternative ways to treat RA while minimizing side effects.