Sodium Aurothiomalate (Gold)

How it works

Gold is taken up by synovial macrophages and modulates immune and inflammatory responses, although the exact mechanism reducing joint inflammation is incompletely understood.

Prescribing in practice

• It can cause serious bone marrow suppression and nephrotoxicity, so blood counts and urinalysis must be checked before each dose and treatment withheld if abnormalities arise.
• Given by deep intramuscular injection, typically with a small test dose before the first full dose.
• It is now seldom used, having been superseded by methotrexate and biologic therapies.

Monitoring

Check full blood count and urine for protein before every injection, as recommended in current prescribing references, and review the skin and mucous membranes for reactions.

Counselling the patient

• Report any rash, mouth ulcers, sore throat, bruising or bleeding without delay.
• Attend for the required blood and urine tests before each injection.

Evidence & guidelines

Injectable gold is a long-established disease-modifying agent but is now rarely used owing to toxicity and the availability of more effective alternatives.