Injectable gold for treating rheumatoid arthritis

Injectable gold has been used to treat several conditions since the 18th century. This review included four trials and 415 patients. Patients receiving gold injections had 30% fewer swollen joints compared to patients receiving placebo. Improvements were also found for blood work and patient and physician assessments in those patients receiving gold injections. 22% percent of the treated patients withdrew from toxicity compared to 4% of patients taking placebo.  

Although its use can be limited by the incidence of serious harms, injectable gold has an important clinically and statistically significant benefit in the short term treatment of patients with rheumatoid arthritis.

Authors' conclusions: 

Although its use can be limited by the incidence of serious toxicity, injectable gold has an important clinically and statistically significant benefit in the short term treatment of patients with rheumatoid arthritis.

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Background: 

Gold compounds have been used in several conditions affecting man since the 18th century (tuberculosis, lupus vulgaris, bacterial endocarditis, etc.) however, in the past decade the use of injectable gold for rheumatoid arthritis has markedly declined, and its clinical usefulness has been doubted.

Objectives: 

To estimate the short-term benefit and risk of side-effects of injectable gold for rheumatoid arthritis.

Search strategy: 

We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to July 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles.

Selection criteria: 

Randomized clinical trials (RCT) comparing injectable gold against placebo in patients with rheumatoid arthritis were included.

Data collection and analysis: 

Methodological quality of the RCTs was assessed by two reviewers (MS, BS) (kappa=1.0). Rheumatoid arthritis outcome measures were extracted by two reviewers from the publications for the 6 month endpoint. Sufficient data was obtained to conduct a pooled analysis of the number of swollen joints, physician global assessment, patient global assessment and erythrocyte sedimentation rate (ESR). Results were analyzed as standardized weighted mean differences for swollen joints and global assessments and weighted mean differences for ESR. Toxicity was evaluated with pooled odds ratios for withdrawals. Heterogeneity was estimated using a chi-square test. Fixed effects models were used throughout.

Main results: 

Four trials and 415 patients were included. A statistically significant benefit was observed for injectable gold when compared to placebo. The standardized weighted difference (effect size) between gold and placebo for the number of swollen joints was -0.5, translating into a percentage change of 30% in favour of gold adjusted for placebo. Statistically significant differences were also observed for ESR and patient and physician assessments. Twenty two percent of the treated patients withdrew from toxicity compared to 4% of controls (OR=3.9 - 95%Cl: 2.1 - 7.2).

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