Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000;1997(2):CD000520.
doi: 10.1002/14651858.CD000520.

Injectable gold for rheumatoid arthritis

P Clark  1 , P Tugwell, K Bennet, C Bombardier, B Shea, G Wells, M E Suarez-Almazor
Affiliations

Injectable gold for rheumatoid arthritis

P Clark et al. Cochrane Database Syst Rev. 2000.

Abstract

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 Key experts in the area were contacted for further published and unpublished articles.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 asessed 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).

Reviewer's 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.

PubMed Disclaimer

Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Injectable gold vs. placebo ‐ Efficacy, Outcome 1 Number of swollen joints.
1.2
1.2. Analysis
Comparison 1 Injectable gold vs. placebo ‐ Efficacy, Outcome 2 Physician global assessment.
1.3
1.3. Analysis
Comparison 1 Injectable gold vs. placebo ‐ Efficacy, Outcome 3 Patient global assessment.
1.4
1.4. Analysis
Comparison 1 Injectable gold vs. placebo ‐ Efficacy, Outcome 4 ESR.
2.1
2.1. Analysis
Comparison 2 Injectable gold vs. placebo ‐ Toxicity, Outcome 1 Withdrawals and dropouts.
2.2
2.2. Analysis
Comparison 2 Injectable gold vs. placebo ‐ Toxicity, Outcome 2 Withdrawals from inefficacy.
2.3
2.3. Analysis
Comparison 2 Injectable gold vs. placebo ‐ Toxicity, Outcome 3 Withdrawals from toxicity.
2.4
2.4. Analysis
Comparison 2 Injectable gold vs. placebo ‐ Toxicity, Outcome 4 Withdrawals from skin and mucosal toxicity.
2.5
2.5. Analysis
Comparison 2 Injectable gold vs. placebo ‐ Toxicity, Outcome 5 Withdrawals from renal toxicity.
2.6
2.6. Analysis
Comparison 2 Injectable gold vs. placebo ‐ Toxicity, Outcome 6 Withdrawals from hemaetological toxicity.
See this image and copyright information in PMC

References

References to studies included in this review

CCC 1973 {published data only}
    1. CCC, The Cooperating Clinics Committee of the American Rheumatism Association. A controlled trial of gold salt therapy in rheumatoid arthritis. Arthritis Rheum 1973;16:353‐8. - PubMed
ERC 1960 {published data only}
    1. ERC, The Research Sub‐committee of the Empire Rheumatism Council. Gold therapy in rheumatoid arthritis. Ann Rheum Dis 1960;19:95‐117. - PubMed
Sigler 1974 {published data only}
    1. Sigler JW, Bluhm GB, Duncan H, et al. Gold salts in the treatment of rheumatoid arthritis. Ann Intern Med 1974;80:21‐6. - PubMed
Ward 1983 {published data only}
    1. Ward JR, Williams HJ, Egger MJ, et al. Comparison of auranofin, gold sodium thiomalate and placebo in the treatment of rheumatoid arthritis. Arthritis Rheum 1983;26:1303‐15. - PubMed

Additional references

Begg 1996
    1. Begg C, Cho M, Eastwood S, et al. Improving the quality of randomized controlled trials: the CONSORT statement. JAMA 1996;276:637‐9. - PubMed
Dickersin 1994
    1. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ 1994;309:1286‐91. - PMC - PubMed
Ellman 1940
    1. Ellman P, Lawrence JS, Thorold GP. Gold therapy in rheumatoid arthritis. Br Med J 1940;2:314‐6. - PMC - PubMed
Epstein 1991
    1. Epstein, W. V., Henke, C.J., Yelin, E.H., and Katz, P.P. Effect of parenterally administered gold therapy on the course of adult rheumatoid arthritis. Ann Intern Med 1991;114:437‐44, 1991. - PubMed
Felson 1993
    1. Felson DT, Anderson JJ, Boers M, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum 1993;36:729‐40. - PubMed
Felson 1995
    1. Felson DT, Anderson JJ, Boers M, et al. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995;38:727‐35. - PubMed
Forestier 1935
    1. Forestier J. Rheumatoid arthritis and its treatment by gold salts. J Lab Clin Med 1935;20:827‐40.
Fraser 1947
    1. Fraser TN. Gold treatment in rheumatoid arthritis. Ann Rheum Dis 1945;4:71‐5. Waine H, Baker F, Mettier SR. Controlled evaluation of gold treatment in rheumatoid arthritis. Calif Med J 1947;66:295‐6. - PMC - PubMed
Jadad 1996
    1. Jadad A, Moore A, Carrol D, et al. Assessing the quality of reports of randomized trials: is blinding necessary?. Control Clin Trial 1996;17:1‐12. - PubMed
Kazis 1989
    1. Kazis LEE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Medical Care 1989;27(S3):S178‐89. - PubMed
Laude 1927
    1. Laude D. Die gunstige beeinflussung scheichender dauerinfekte durch solganal. Munch Med Wochenschr 1927;74:1132.
OMERACT 1993
    1. OMERACT. Conference on Outcome Measures in Rheumatoid Arthritis Clinical Trials. J Rheumatol 1993;20:526‐91. - PubMed
Slot 1934
    1. Slot G, Deville PMP. Treatment of arthritis and rheumatism with gold. Lancet 1934;73‐6.

Publication types