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Myochrisine, Solganol

( gold salts )

Purpose

To reduce inflammation and retard disease progression.

 

Indications

Rheumatoid arthritis and some other forms of synovitis.


Dosage

50 mg per week by intramuscular injection for twenty weeks, then one to two injections per month thereafter. Many doctors use smaller doses for the first two injections to test for allergic reactions to the injections. Sometimes doctors will give more or less than this standard dosage depending upon your body size and response to treatment. "Maintenance" gold treatment refers to injections after the first twenty weeks (which result in about 1,000 mg of total gold). The dosage and duration of maintenance therapy varies quite a bit; with good responses, the gold maintenance may be continued for many years, with injections given every two to four weeks.


Side effects

The gold salts accumulate very slowly in the tissues of the joints and in other parts of the body. Hence, side effects usually occur only after a considerable amount of gold has been received, although allergic reactions can occur even with the initial injection. The major side effects have to do with the skin, the kidneys, and the blood cells. The skin may develop a rash, usually occurring after ten or more injections, with big red spots or blotches, often itchy. If the rash remains a minor problem, the drug may be cautiously continued, but occasionally a very serious rash occurs following gold injections.


The kidney can be damaged so that protein leaks out of the body through the urine. This is called nephrosis or the nephrotic syndrome if it is severe. When it is recognized and the drug is stopped, the nephrosis usually goes away, but cases have been reported in which it did not reverse.


The blood cell problems are the most dangerous. They can affect either the white blood cells or the platelets, those blood cells that control the clotting of the blood. In each case, the gold causes the bone marrow to stop making the particular blood cell. If the white cells are not made, the body becomes susceptible to serious infections that can be fatal. If the platelets are not made, the body is subject to serious bleeding episodes that can be fatal. These problems almost always reverse when the drug is stopped, but reversal may take a number of weeks, during which time the person is at risk for a major medical problem.


There are other side effects, such as ulcers in the mouth, a mild toxic effect on the liver, or nausea, but they are usually not as troublesome. Overall, about one-quarter of users have to stop their course of treatment because of the side effects. One or two percent of users experience a significant side effect; the other users don't really notice very much of a problem, even though a serious side effect may be about to occur. Less than one in a thousand times there may be a fatal side effect. With careful monitoring, the drug is reasonably safe and its benefits justify its use, since over 70% of those treated with gold show moderate or marked improvement. However, you must maintain your respect for this treatment and keep up regular blood tests to detect early side effects. One final note: Most side effects occur during the initial period of twenty injections. Serious side effects during the maintenance period are less common.


You must learn to be patient with gold treatment. The gold accumulates slowly in the body and good responses are almost never seen in the first ten weeks of treatment. Improvement begins slowly after that and major improvement is usually evident by the end of 1,000 mg, or twenty weeks. Similarly, if the drug is stopped, it requires many months before the effect is totally lost. In one famous study, the gold group was still doing better than the control group two years after the drug had been stopped, although most of the effect of the drug had been lost by that time. After a side effect, many doctors will suggest that the drug be tried again. Often, this can be worthwhile if the approach is very cautious, since the drug is frequently tolerated the second time around. At the Stanford Arthritis Center we do not try gold salts again if there has been a problem with the blood, but we will use it again cautiously after mild skin reactions or mild amounts of protein loss through the urine.


To minimize the chance of serious side effects, most doctors recommend that a check be made of the urine for protein leakage, of the white cells and the platelets, and that the patient is questioned about skin rash before every injection. This is good practice. Unfortunately, the combination of twenty doctor visits, twenty injections, twenty urinalyses, twenty blood counts, and so forth, makes the cost of initiating gold treatment approximately $1,200 when pursued in this manner. There are some ways to decrease this cost while preserving the safety. You can ask your doctor to prescribe some test kits so that you can test your urine for protein at home. This is a very easy technique. You can ask if it is possible to have just a platelet smear and a white count rather than a complete blood count each time. You can inquire whether it is possible to have the nurse give an injection after checking the blood count without actually having a doctor visit every week. And, some people have successfully been given their own shots at home with the help of their family, although this is not acceptable to many. By using such techniques, you can save half to three-quarters of the cost of a course of gold treatment.

         
         

     

         

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