Gold preparations

Definition
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Antirheumatic drugs, basic therapeutics. For example, auranofin, sodium aurothiomalate.

Indication
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Psoriatic arthritis, rheumatoid arthritis.

Notice! Before starting therapy, pregnancy must be ruled out and effective contraception must be carried out during therapy!

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Limited indication
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Insulin-dependent diabetes mellitus, sun exposure (including artificial UV radiation).

Undesirable effects
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See Table 1.

Interactions
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See Table 2.

Contraindication
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Pregnancy, lactation, agranulocytosis, atopic diathesis, autoimmune diseases (dermatomyositis, systemic lupus erythematosus, scleroderma), haematopoietic disorders, bleeding tendency, ulcerative colitis, severe liver and kidney dysfunction, thrombocytopenia, active pulmonary tuberculosis, hypersensitivity to heavy metals.

Tables
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Side effects of gold preparations

Airways	allergic alveolitis, bronchiolitis, interstitial pulmonary fibrosis (under therapy 1 time/year X-ray control of the thorax!)
blood, lymph	Agranulocytosis, hypo- to aplastic or hemolytic anemia, Eosinophilia (therapy discontinuation in > 12%) Leukopenia, neutropenia, thrombocytopenia (discontinuation of therapy if < 100,000 platelets/μl), pancytopenia, thrombocytopenic purpura
GIT	Loss of appetite, vomiting, diarrhea Cholestasis, jaundice, hepatitis Gastrointestinal bleeding Transaminase elevations, rarely hepatic necrosis
Urinary tract	Albuminuria, hematuria, proteinuria (discontinuation of therapy at > 300 mg protein/l urine), cylindruria Glomerulonephritis, immune complex nephritis gold nephropathy, tubular necrosis acute renal failure
Skin	allergic exanthema, pityriasis rosea-like reactions, pruritus, alopecia, Quincke's edema, anaphylactic shock, Lyell's syndrome gingivitis, stomatitis Photosensitization gray-blue pigmentation, especially in light-exposed areas intradermal gold deposits drug-induced lupus erythematosus onycholysis, hyperhidrosis
Cardiovascular	bradycardia, tachyarrhythmia
Nervous system	EEG changes, headache, seizures, hallucinations, confusional states Encephalopathy, encephalitis, neuropathy, neuritis Guillain-Barré syndrome
Sensory organs	metallic taste Chrysiasis (gold deposits in eye tissue) corneal ulcers iritis, conjunctivitis, neuritis optic nerves
supporting apparatus	Arthralgias Pain at the injection site in case of i.m. application Application

Significant interactions of gold preparations

Butazone	Reciprocal toxicity ↑, avoid combination.
Chloroquine	Retinopathy risk ↑.
Clozapine	Agranulocytosis, avoid combination
Iron	Gold effect with oral administration ↓
Metamizole	reciprocal toxicity ↑, avoid combination
NSAIDS	Blood formation disorders, mutual toxicity ↑.
Penicillamine	Blood formation disorders, kidney damage, gold effect ↓, avoid combination
Cytostatics	mutual toxicity ↑, avoid combination