Active progressive rheumatoid arthiritis inadequately controlled by NSAIDs 

I

Adverse reactions to gold therapy may occur during treatment or many months after discontinuation. Incidence of toxic reactions is apparently unrelated to gold plasma levels, but may relate to cumulative body content of gold.

Auranofin- diarrhoea,loose stools. Nausea, vomiting, anorexia, abdominal cramps, ulcerative enterocolotis. Thrombocytopenia, eosinophillia, anemia.

Hypersens to drug. Uncontrolled diabetes, severe debilitation, renal disease.hepatic dysfunction,infectious hepatitis, marked hypertension, uncontrolled CHF, blood dyscrasias

Special precautions:

Before instituting treatment, rule out pregnancy.

Perform complete blood test.

Discontinue use of salicylates, NSAIDs, and systemic corticosteroids, before instituting gold therapy.

Indications-

Active progressive rheumatoid arthiritis inadequately controlled by NSAIDs

Dosage-

Auronofin- Initially 6mg daily in 2 divided doses morning and evening with meals If tolerated continue for minimum 3 to 6 months as a single daily dose

If response is inadequate after 6 months increase to maximum 3mg thrice daily Discontinue after further 3 months if response remains inadequate

Children - not recommended

EVIDENCE BASED MEDICINE (April 2003)

Pain of Osteoarthiritis

Comparative effectiveness of various interventions

Beneficial

1. Systemic simple analgesics (eg paracetamol for short term pain relief, and improvement in function)

2. Systemic NSAIDs (short term pain relief and improvement in function)

3. Topical agents (short term pain relief)

Likely to be beneficial

1. Education, dietary advice,empowerment and support ( improved knowledge of disease and pain relief)

2. Physical support (pain relief and improvement in function)

KEY POINTS

1. There is no good evidence that NSAIDs were superior to simple analgesics such as paracetamol or to suggest that any one of the many available NSAIDs had greater efficacy in relieving pain of osteoarthritis.

2. One systematic review of randomised controlled trials has found that topical agents provide pain relief in patients with osteoarthritis and offer a non-toxic alternative to systemic drug treatment. However there is no evidence to indicate whether the prescribed agents were superior to less expensive, non-prescribtion drugs over the counter (OTC) alternatives, or to other local treatments such as hot or cold packs.

1. Notify physician, if itching, rash, sore mouth, indigestion, metallic taste, easy bruising or nose bleed occur

2. Increased joint pain may continue 1 or 2 days after injection,and usually subsides after the first few injections.

3. Minimise exposure to sunlight

4.Observe careful oral hygiene.

5. Warn women of childbearing potential of the risks of using gold therapy.

6.Allergies- tell your doctor if you have ever had any unusual or allergic reaction to gold or ther metals. Also tell your doctor if youare allergic to any other substances, such as foods, presrvatives or dyes.

7.Pregnancy - studies on birth defects with gold compounds have not been done in humans. However, studies in animals have shown that gold compounds may cause birth defects.

8.Breast feeding- aurothioglucose and gold sodium thiomalate pass into the breast milk and may cause unwanted effects on nursing babies.

9 Children - auroglucose and gold compounds have been tested in children and have not been shown to cause different side effects or problems than they do in adults.

10. Elderly- these medicines have not been shown to cause different side efects or problems in older people than they do in younger adults

11.Other medicines - Let your doctor know what other medicines you are taking, so that he can advice you accordingly.

Penicillamine - chance of side effects may be increased

10. Other medical problems - Tell your doctor if you have any other medical problems especially - Blood or blood vessel disesase or Colitis or Kidney disease or Lupus erthematous or Sjogrens syndrome or Skin disease - chance of unwanted effects may be increased

11. Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.

12. Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.

13. Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.

Pregnancy:

Gold therapy is contraindicated in pregnant women.

Lactation:

Injectable gold is excrteted in the breast milk .