Antiarthritic Drugs: Generic and Brand Names
- Gold Compounds
- auranofin (Ridaura)
- gold sodium thiomalate (Aurolate)
- Other antiarthritic agents
- anakinra (Kineret)
- etanercept (Enbrel)
- hyaluronidase derivatives (Synvisc)
- penicillamine (Depen)
- sodium hyaluronate (Hyalgan)
Disease Spotlight: Arthritis
Arthritis is a group of more than 100 types of joint pain or disease and related conditions, all involving an inflammatory process in the joints that causes pain and damage to cartilage and bone. It affects people of all ages, sexes, and races and is one of the leading causes of disability in the United States: about 53.2 million US adults (21.2%) reported diagnosed arthritis from 2019 to 2021 (CDC). Symptoms include swelling, pain, stiffness, and decreased range of motion, and over time the joint changes become permanent. NSAIDs are often used in rheumatoid arthritis (an autoimmune disorder affecting the small joints) and osteoarthritis (arthritis of the weight-bearing joints, common in older people).
Gold Compounds
Gold salts treatment (chrysotherapy) is for patients with rheumatic inflammatory conditions who do not respond to the usual anti-inflammatory therapies. In chrysotherapy, macrophages take up gold, which then inhibits phagocytosis.
Worth knowing for context: gold therapy is now rarely used in the United States. Methotrexate is the anchor, first-line disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis, with biologics such as TNF inhibitors and targeted synthetic DMARDs added when methotrexate alone does not control disease (American College of Rheumatology, 2021). Gold compounds still appear in pharmacology courses and older regimens, so they remain useful to recognize.
Therapeutic Action
Gold compounds inhibit phagocytosis and the release of lysosomal enzymes, which inhibits tissue destruction. That action lets gold salts suppress and prevent some arthritis and synovitis.
Indications
Gold compounds treat selected cases of rheumatoid and juvenile rheumatoid arthritis that have not responded to standard therapy. They only prevent further damage, so they work best early in the disease. Auranofin is an oral agent for long-term therapy of rheumatic disorders. Gold sodium thiomalate is injected for early treatment of rheumatic disorders.
Pharmacokinetics
Here are the characteristic interactions of gold compounds and the body in terms of absorption, distribution, metabolism, and excretion:
| Route | Onset | Peak | Duration |
|---|---|---|---|
| Oral | Slow | 4-6 h | N/A |
| Half-life (T1/2) | Metabolism | Excretion |
|---|---|---|
| 3-7 days | N/A | urine and feces |
Contraindications and Cautions
Known allergy to gold. Severe diabetes, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, a history of toxic levels of heavy metals, and pregnancy or lactation.
Adverse Effects
- Skin: dermatitis, pruritus, exfoliative dermatitis, allergic reactions ranging from flushing, fainting, and dizziness to anaphylactic shock
- GI: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, other GI inflammation
- Respiratory: gold bronchitis, interstitial pneumonitis
- Hema: bone marrow depression
- GU: vaginitis, nephrotic syndrome
Interactions
Penicillamine, antimalarials, cytotoxic drugs, and immunosuppressive agents carry the potential for severe toxicity.
Nursing Considerations
Nursing care for patients on antiarthritics mirrors care for patients on nonsteroidal anti-inflammatory drugs and related agents.
Frequently Asked Questions
What are antiarthritic drugs used for? They slow or block the inflammation and joint damage of rheumatoid arthritis rather than just easing pain. Gold compounds and other agents like penicillamine, etanercept, and anakinra suppress the immune-driven tissue destruction at the heart of the disease.
Are gold injections still used for rheumatoid arthritis? Rarely in the United States. Gold therapy has largely been replaced by safer, more effective drugs. Methotrexate is now the first-line DMARD, with biologics added when needed (American College of Rheumatology, 2021).
Why does gold therapy work best early in the disease? Gold compounds only prevent further joint damage; they do not reverse destruction that has already happened. Starting before significant joint changes set in gives the best chance of preserving function.
What are the most serious adverse effects of gold compounds? Bone marrow depression, severe skin reactions including exfoliative dermatitis, nephrotic syndrome, and interstitial pneumonitis. Patients need regular monitoring of blood counts, urine protein, and skin, and any rash, mouth sores, or bruising should be reported promptly.
How common is arthritis? Very common. About 53.2 million US adults (21.2%) reported diagnosed arthritis from 2019 to 2021, making it one of the leading causes of disability in the country (CDC).
Is nursing care for antiarthritic drugs different from NSAID care? The core nursing care mirrors care for patients on nonsteroidal anti-inflammatory drugs and related agents, with added attention to the bone marrow, kidney, skin, and lung toxicity that limit gold and other DMARD therapy.