Abstract
Gold salts of monovalent gold (AU I) with a gold-sulfur ligand (aurothiolates) are the only form of gold currently in use for the management of rheumatoid arthritis (RA). Aurothiolates have limited success and are associated with a high incidence of side-effects. Metallic gold (AUo) is non-toxic and used extensively in dentistry. Monoatomic metallic gold is generated in vivo from AU I salts, during oxidation to trivalent gold (AU III). Monoatomic gold tends to form clusters of colloid particles. It is postulated that the active ingredient in aurotherapy is AUo and the side-effects are caused by AU III. To test this postulate, ten RA patients with long-standing erosive bone disease not responding to previous treatment were recruited from a private practice. Clinical and laboratory evaluations were performed prior to oral administration of 30 mg of colloidal AUo daily and thereafter weekly for 4 weeks and monthly for an additional 5 months. There was no clinical or laboratory evidence of toxicity in any of the patients. The effects of the colloidal gold on the tenderness and swelling of joints were rapid and dramatic, with a significant decrease in both parameters after the first week, which persisted during the study period. The mean scores for tenderness and swelling were, respectively, for pre- and post-1 week 58.8 and 18.2 ( p 0.01) and 42.5 and 15.9 ( p 0.01). By 24 weeks of gold administration, the mean scores were ten times lower than the pre-treatment levels being, respectively, 5.4 and 3.3 for tenderness and swelling. As a group, there was a significant improvement of functional status by 24 weeks of gold therapy: three patients were in clinical remission and one patient's status improved from totally disabled to full-time work. Evaluated individually, nine of the ten patients improved markedly after 24 weeks of colloidal gold at 30 mg/day. The cytokines interleukin6 (IL-6) and tumour necrosis factor alpha (TFN- alpha ), the immune complexes IgG and IgM, and rheumatoid factor were significantly suppressed by the colloidal gold. The results of this open trial in ten patients with long-standing erosive RA not responding to previous treatment support the postulate that colloidal gold is indeed the active ingredient in aurothiolate therapy and that the side-effects are mainly due to the AU III generated by oxidation of AU I. Colloidal AUo could become an effective and safer alternative to the aurothiolates in the management of RA patients.