Gold therapy was one of the first treatments for rheumatoid arthritis, but is it still worth investing in?

It sounds like something from a James Bond movie, but gold injections were one of the original medications developed specifically to treat rheumatoid arthritis and have been used for more than 75 years.

Gold injections are part of a class of RA drugs known as disease-modifying anti-rheumatic drugs (DMARDs) because it not only treats the symptoms of RA, like pain and swelling of the joints, but it can also prevent joint damage and disability.

Although gold injections can be effective for some people, their use has declined dramatically in the last 20 years thanks to the advent of more effective and better tolerated biologic and non-biologic DMARDs, such as methotrexate.

How Gold Works

Several forms of gold therapy are available as an RA treatment. The most common is injectable gold — gold sodium thiomalate (Myochrysine). There is also an oral gold formulation, auranofin (Ridaura), but it's less effective than the injectables. Gold is usually given as a weekly injection and may eventually be given monthly.

Although it’s not clear how gold works to treat RA, it’s thought to affect the abnormal immune response involved in triggering rheumatoid arthritis.

It can take a while to see any improvement after treatment with gold therapy. Most people who do respond to the treatment see improvement in symptoms after about three to six months of gold therapy.

Gold Injections: Not for Everyone

As with many other treatments, gold therapy doesn’t work for everyone. Barbara Carley, a consultant in Sarasota County, Fla., had gold injections 40 years ago and remembers that the injections were very painful.

“For me, it did not work,” said Carley. “For some, it works great and can help to bring down inflammation.”

Statistics offer a muted response. An estimated two or three out of every 10 people who try gold therapy do not respond to the treatment. Another two or three stop taking it for other reasons.

Side effects of gold therapy affect about a third of people. These include severe skin rashes, skin discoloration, kidney damage, bleeding disorders, and bone marrow suppression. The numerous side effects associated with gold therapy require close monitoring by your health care professionals.

Gold Injections: A Therapy in Decline

Due to the high number of side effects and limited effectiveness, gold injections are rarely used now. Patients and doctors have largely abandoned them in favor of safer, more effective DMARDs for rheumatoid arthritis.

“They are prescribed with extreme infrequency,” said rheumatologist Jinoos Yazdany, MD, assistant professor of medicine at the University of California, San Francisco. “The efficacy and side effects of the newer medications are so good at slowing down the course of the disease that other drugs should be considered first before gold therapy.”

For example, Dr. Yazdany cites a 2009 survey of 7,000 Medicare recipients using medications to treat rheumatoid arthritis that showed only one person was getting gold therapy.

Yazdany says continuing use of gold therapy may be appropriate for those who have been on the drug for many years and are doing well on it. Otherwise, other DMARDs should be considered as a first line of treatment for people newly diagnosed with rheumatoid arthritis.