How low can you go? Use of very low dosage of gold in patients with mucocutaneous reactions.

OBJECTIVE

We identified a group of patients with rheumatoid arthritis (RA) who were sensitive to both the beneficial and the side effects of intramuscular (im) gold treatment and whose disease was well controlled with doses of gold between 2 mg every 6 weeks and 5 mg weekly. We describe the clinical course of these patients and their management aimed at maximizing the effectiveness of gold therapy.

METHODS

Patients successfully treated with maintenance doses of im gold (< 20 mg/mo and not more than 10 mg/dose) were identified by chart review. Clinic records were reviewed to extract clinical and laboratory data.

RESULTS

The population consisted of 11 female and 2 male patients with RA. Eleven were seropositive and 2 had Felty's syndrome. All developed mucocutaneous side effects within 20 weeks of beginning im gold therapy, at a time when RA had improved markedly compared to pretreatment status. Side effects recurred with sequential dosage adjustments so that doses > 10 mg were not tolerated. Side effects were managed by temporary discontinuation of gold until side effects resolved and resumption of treatment using usually 50% lower dosage. When side effects recurred the dosage was reduced further by 50%. Final maintenance dose was 2 mg every 4 weeks in 1 patient, 2 mg weekly in 1, 3 mg weekly in 3, 5 mg monthly in 1, 10 mg every 3 weeks in 2, 10 mg every 4 weeks in 2, 10 mg every 6 weeks in 1, and 5 mg weekly in 2 patients. All patients improved and 6 are in complete remission. Mean duration of therapy was 5.5 yrs.

CONCLUSION

The minimum effective dose of im gold is not known. Dose and dose intervals should be individualized for optimal benefits and tolerability.