Little Benefit Seen in Gold Salt Injections
One of the oldest and most popular treatments for rheumatoid arthritis appears to have little long-term effect on the course of the disease, according to a new five-year study by California researchers.
The study, by researchers at UC San Francisco and the Kaiser-Permanente Medical Center in Oakland, found that patients who received injections of gold salts for at least two consecutive years did no better on average than those who did not receive the drug.
“We didn’t find any basis for the claim that giving two years of this treatment made any difference . . . in terms of the course of the disease,” said Dr. Wallace Epstein, a UC San Francisco professor of medicine and lead author of the article in the Annals of Internal Medicine.
The 574-patient study raises new questions about a conventional therapy used for 60 years to treat rheumatoid arthritis, the most severe form of the painful inflammatory joint disease and a form believed to affect 2.1 million Americans.
Experts described the paper as important and provocative but differed in their assessment of the results. One said it should serve as a reminder of the limitations of all rheumatoid arthritis treatments.
“The most important message here is that most of the things we have simply aren’t good enough,” said Dr. Bevra H. Hahn, chief of rheumatology at UCLA School of Medicine. “It goes to show that we need something more effective than what we have.”
About 40% of all rheumatoid arthritis sufferers under the care of a specialist take injections of gold salts, Epstein said. The therapy is used in patients whose disease cannot be controlled by aspirin or anti-inflammatory drugs.
Gold was first used against rheumatoid arthritis in the 1920s, when the disease was thought to be an infection by the tuberculosis germ. Rheumatoid arthritis is believed to be an autoimmune disorder, in which the immune system attacks joints and surrounding soft tissues.
Epstein’s group followed 822 rheumatoid arthritis sufferers over a five-year period, tracking changes in their ability to function and in the number of painful joints. They compared those who had received gold therapy to those who had not.
Most of those not taking gold took other drugs, such as oral prednisone, hydroxychloroquine and penicillamine.
The researchers found little change in the functioning and in the number of painful joints in the 574 patients who completed the study interviews.
Epstein cautioned that he is not ruling out the possibility that some patients improved or worsened during the study period. He emphasized that the conclusion applies to patients on the average, not necessarily each individual patient.
Several experts in the field said the results are open to interpretation. For example, one said the lesson may be not that gold does not work, but that it works no better or worse than the other drugs taken by patients who did not receive the gold injections.
Hahn, a UCLA professor of medicine, attributed Epstein’s findings to the length of the study. She said gold can help many patients in the short run; but in the longer run, its effectiveness wanes for some, while others stop taking it because of side effects.
“My view of gold is that for most people it can buy a few years of improvement and then you’ll need to introduce another (drug),” Hahn said. “For some people, you never get any benefit and can get side effects. For some people it works very well and it works forever . . . although it never cures the disease and you never get a true remission.”
