Gold compounds in rheumatic diseases--1.

Gold complexes diminish synovitis and improve therapeutic outcome in rheumatoid arthritis, psoriatic arthritis, some forms of juvenile chronic arthritis, and palindromic rheumatism. The decision to treat a patient with a gold compound should not be undertaken lightly. It should be understood by the patient that the commitment to therapy is potentially long-term, that major benefit is not assured, and that there is, approximately, a 50% probability of an adverse reaction which may terminate treatment. Nevertheless, most adverse effects are mild and transient and the probability of good control, even remission, in an otherwise threatening disease, is sufficiently high to justify a therapeutic trial in the majority of patients. Those patients whose rheumatoid arthritis appears to respond to gold may be encouraged to continue long-term therapy with maintenance doses, in view of the evidence of sustained efficacy in most patients and of the declining risk of adverse reactions after the first 12 months.