Going for the Gold

Story and Photos by: FÜSUN ATALAY ~ Copyright © 2004

More desirable is sound health than all the gold in the world.
— Turkish proverb —

Symbol of great purity and value — and probably the first pure metal known to man — gold has been highly valued from the earliest times. The alchemists’ symbol, a circle with a dot in the centre, indicated that gold was compared to the sun and called the solar metal not only for its colour, value and beauty, but also for its innate healing powers for a number of ailments.

Archeological digs which go as far back as 4,500 years ago indicate that gold was used extensively in amazing dental work performed by Egyptian dentists. Romans commonly used gold salves for the treatment of skin ulcers. The shaman or curandro (the medicine man) of the American Indians also relied on the powers of gold for a multitude of purposes, by boiling a gold nugget in water and making the patients drink this potion to cure diseases, the foremost among which was mental illness.

Evidence of the ancient belief in the restorative power of gold is also found in China, where ancient medical journals record the effectiveness of gold — in powdered or pill form — in treating boils, epilepsy, mental disorders and palpitations of the heart.

But the earliest reference to the use of gold with reference to arthritis is found in medieval Europe, where alchemists mixed powdered gold into drinks to comfort sore limbs.
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Exotic as it sounds, gold, in modern medicine, has been used for years as one of the standard treatments for rheumatoid arthritis.

Many experts — including Dr. Proton Rahman, a rheumatologist with the faculty of medicine at Memorial University and the Health Care Corp. of St. John’s — consider this precious metal to be among the most effective drugs to reduce the inflammation in the joints and decrease the usual symptoms of pain, swelling and stiffness.

“It is used in the treatment of rheumatoid arthritis — where there is a real indication for gold,” says Rahman.

The other indications for intra-muscular gold is palindromic rheumatism and, occasionally, in Still’s disease.

The cause of rheumatoid arthritis is not known, however, “a lot of genetic studies in the United States and U.K. have found evidence pointing to rheumatoid arthritis having a strong genetic component,” notes Rahman.

Although it is common among the general population, Rahman points to this strong genetic component as a possible explanation for the higher frequency of rheumatoid arthritis on the west coast of Newfoundland.

“This is likely as a result of a founder effect, as it is reasonable to assume that the population in the west coast is relatively homogeneous as it has arisen from a limited number of founders.”

The “founder effect” refers to the gene pool in a population whose ancestors have come from a very few countries. Settlers in Newfoundland were immigrants from Ireland and South West England. Consequently, diseases that are abundant today are the ones that were common among the original Irish and British settlers on the west coast.

Since there is no cure for rheumatoid arthritis, therapy is aimed at controlling the symptoms of the disease. Various treatments are applied to relieve the pain, reduce inflammation, prevent damage to joints, prevent deformities and keep joints mobile and functioning properly. It is not proven that therapy can stop the basic disease process, but it can slow it down and relieve the immediate symptoms of the disease.

There are two classes of medications used in the treatment of rheumatic arthritis: fast-acting “first-line drugs” and slow-acting “second-line drugs.” Acetylsalicylate (aspirin), naproxen, ibuprofen (Advil, Motrin) and corticosteroids (cortisone), which doctors consider first-line drugs, are used primarily to reduce pain and inflammation.

Rheumatoid arthritis, however, requires more than these non-steroidal anti-inflammatory drugs, known as NSAIDs (pronounced “en-saids”).

While the NSAIDs and corticosteroids can relieve joint inflammation and pain, they do not actually prevent joint destruction and deformities. Treatment, with other than first-line drugs to stop progressive damage to cartilage, bone and adjacent lining tissues, is needed for effective management of the disease.

These “second line” drugs are referred to as disease-modifying anti-rheumatic drugs, or DMARDs. Although they promote disease remission and prevent progressive joint destruction, DMARDs, such as methotrexate, hydroxychloroquine (Plaquenil) and gold, are not anti-inflammatory agents. Therefore, in some cases they may have to be used in combination with first-line drugs.

Many people may not be familiar with the gold treatment, which has been effective for controlling some types of arthritis and related diseases. As a compound, gold is taken in tablets or given as intra-muscular injections initially on a weekly basis. Treatment can then continue for months or even years.

“Rheumatoid arthritis is an autoimmune disease that causes the immune system to over function which, in turn, attacks its own joints to cause inflammation and swelling in the joints,” Rahman explains. “DMARDs modify the immune system so that it is more regulated in the hopes that the disease will not be as active.”

Who would be a good candidate for the gold treatment?

Rahman’s professional assessment is, “a patient with rheumatoid arthritis who has a contraindication showing that he or she cannot receive methotrexate, a first-line DMARD, may be a good candidate for the gold treatment under the supervising of the specialist.”
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Injectable gold salts (Myochrysine, Solganal) have been used to treat rheumatoid arthritis for more than 60 years, while oral gold Auranofin (Ridaura) was introduced in the 1980s.

Gold treatment appears to work best in the early stages of rheumatoid arthritis, and may also be effective in people with active joint pain and swelling. It does not cure the disease; nor does it correct or repair existing deformities.

However, Rahman agrees that gold treatment is a good alternative for effective therapy. Ten to 15 per cent of his patients with rheumatoid arthritis receive or are being considered for gold therapy.

Dr. Trisha Macnair, medical adviser to the BBC News health website, emphasizes that people need to be patient to see an effect from gold injections. It often takes three to six months to determine whether a person is getting benefits from gold salts. She points out that while “gold does tackle the inflammation, it is not a pain-killer and, therefore, most people should continue taking their other medications such as aspirin or NSAIDs.”

Intra-muscular gold injections are usually administered once a week initially for six months or longer. In patients who have a good response, the medication usually can be tapered to once a month. Routinely, a test dose is given first to rule out allergy, as some may have severe reactions to gold. Gold tablets, on the other hand, are taken once or twice daily.

In addition to its benefits — oral as well as injectable — gold can also cause a variety of side effects which may mean that treatment has to be stopped. Problems with the blood, kidney or skin; mouth ulcers, altered taste, sore throat, fever, bruising, bleeding and breathlessness are all common side effects.

The treating physician should look out for any sign of a skin rash, mouth sores, kidney damage with leakage of protein in the urine, and bone marrow damage with anemia and low white cell count. Patients receiving gold treatment are also regularly monitored with blood and urine tests.
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Despite certain drawbacks, most arthritis specialists still view gold salt injections as an important form of treatment for rheumatoid arthritis. Research carried out over the last three decades have shown that this form of treatment is effective, and in some sufferers it even may slow down damage to the joints.

A small group of people with rheumatoid arthritis experience dramatic and long-lasting improvement on gold. The Cochrane Group is a well-established body that reviews many treatment methods. Their most recent study of the effectiveness of injectable gold in treating rheumatoid arthritis — dated Jan. 27, 2004 — found a 30 per cent improvement in the number of swollen joints when gold was used. Their report concluded that, “Although its use can be limited by the incidence of serious toxicity, injectable gold has a clinically important and statistically significant benefit in the short-term treatment of patients with rheumatoid arthritis.”

Like with many diseases, living and coping with arthritis is not easy. And although it is not a curable ailment, its progression may be slowed and the pain caused by it somewhat alleviated.

A person with rheumatoid arthritis should do his research and then ask his doctor informed questions about the types of treatments and available options. Once a patient has done this, he or she may have taken the first step in the direction of a better quality of life.

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