II. Indications (Replaced by Methotrexate)
- Rheumatoid Arthritis
- Seropositive Rheumatoid Arthritis
III. Efficacy (replaced by Methotrexate)
- Response rate
- Injection: 75%
- Oral: 50-60%
- Slowest therapeutic response of DMARD (3-6 months)
IV. Adverse Effects
- Gold Injection
- Pruritic rash (20%)
- Stomatitis
- Proteinuria due to membranous nephritis (5%)
- Hematologic (1%)
- Leukopenia (more common)
- Thrombocytopenia
- Anemia (less common)
- Gold Pneumonitis (rare)
- Gold colitis (rare)
- Nitritoid Reaction (uncommon)
- Flushing and vasodilation
- Hypotension and Tachycardia
- Occurs 5-30 minutes after Gold Injection
- Oral Gold
- Diarrhea (common and may limit compliance)
- Dermatitis (less common than with injection)
V. Monitoring
- Indications to hold Gold Therapy
- Urinalysis with >2+ Proteinuria
- Complete Blood Count with cell line depression
- Gold Injection
- Urinalysis for Proteinuria
- Obtain with each injection
- Complete Blood Count (CBC)
- Obtain weekly with each injection for 8 weeks
- Obtain monthly while on weekly injections
- Obtain every 3 months while on monthly gold
- Urinalysis for Proteinuria
- Oral Injection
- Complete Blood Count (CBC) every 3 months
- Urinalysis for Proteinuria every 3 months
VI. Dose
- Oral: 3 mg PO bid