Researchers Find How Gold Salts Work for Arthritis

Thursday October 25, 2007

Doctors first used injections of gold salts to treat arthritis in the early 1900s. It was an expensive treatment, fraught with side effects including rashes, mouth sores, and kidney damage. Sometimes gold even affected the bone marrow's ability to manufacture new blood cells. It took months for the drug to be effective when it did work. But how did it work? Until now, the mechanism was unclear.

Researchers at Duke University Medical Center, along with colleagues from the University of Pittsburgh and the Karolinska Institute in Sweden, have discovered that gold inhibits the release of HMGB1 by interfering with interferon beta and nitric oxide, two helper molecules that facilitate the release of HMGB1 from cells. HMGB1 is involved in transcription of genetic information in DNA to its RNA equivalent. When HMGB1 is released from cells through normal processes or cell death, it stimulates the immune system and promotes inflammation. HMGB1 is not distributed evenly throughout the body. Synovial fluid and synovial tissue contains an "unusually high amount" of HMGB1, according to researchers. Animal studies and human studies are needed to follow-up the lab studies, but researchers believe the discovery may eventually lead to newer, safer gold-based treatments.

The increasing popularity of methotrexate and biologic drugs to treat rheumatoid arthritis have all but replaced the use of gold. According to rheumatologist Scott J. Zashin, M.D., as gold shots have become less utilized, companies have stopped making the medication. There were two formulations of gold, Solganol and Myochrysine. Only Myochrysine (gold sodium thiomalate) is now available and often patients will develop a reaction to this formulation making it unacceptable to continue treatment. Oral gold (Ridaura, auranofin capsules) had only minimal benefit in treatment so it was uncommonly prescribed.

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