Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Gold sodium thiomalate is a gold-containing
chemical (salt) used in treating rheumatoid arthritis. Other gold salts
available include injectable aurothioglucose (Solganal) and oral auranofin
(Ridaura). It is not well understood exactly how gold salts work. In patients
with inflammatory arthritis, such as adult and
juvenile rheumatoid arthritis,
gold salts decrease the inflammation of the joint lining and also prevent the
inflammation from destroying the bone and cartilage surrounding the joint.
Because they prevent destruction of joints (in contrast to antiinflammatory
drugs that just treat symptoms and signs of arthritis but do not prevent the
destruction) gold thiomalate is known as a disease-modifying antirheumatic drug
(DMARD). Gold salts also may be referred to as second-line drugs because they
are often considered when the arthritis persists in spite of the use of
antiinflammatory drugs (NSAIDs and corticosteroids) which are not DMARDs. The
term, second line, may be misleading, however, since anti-inflammatory drugs and
DMARDs in general should be used together because of their different mechanisms
of action and additive effects.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Injectable solution: 50 mg/ml.
STORAGE: Gold sodium thiomalate should be stored at 20 to 25 C (68 to 77 F)
and protected from light.
PRESCRIBED FOR: Gold sodium thiomalate is used in the treatment of active,
progressive, or destructive forms of inflammatory arthritis, such as adult and
juvenile rheumatoid arthritis. Off label (non-FDA approved) uses include
Felty's
Syndrome (a rare disorder that includes rheumatoid arthritis, a swollen spleen,
and decreased white blood cell count) and psoriatic arthritis.
DOSING: The usual initial adult dose is 10 mg followed by 25 mg for the
second dose, then 25–50 mg weekly until gold toxicity or substantial clinical
improvement occurs, or a cumulative dose of 1 g has been administered.
The usual dose for children is based on the weight of the child and is
proportional to the adult dose. The maximum single dose for children younger
than 12 years of age is 50 mg. After an initial test dose of 10 mg, one dosage
regimen recommended for children is 1 mg/kg per week.
DRUG INTERACTIONS: The concurrent use of penicillamine (Cuprimine, Depen) and
gold sodium thiomalate should be avoided as the combination decreases the levels
and efficacy of both drugs due to chelation (binding of the gold salt with
penicillamine). Gold sodium thiomalate should not be used in combination with
atovaquone/proguanil (Malarone), an
antimalarial drug, as the combination may
increase the risk of serious blood abnormalities. (Either drug alone may have
such effects, but the combination is more likely to cause them, i.e., the
toxicity is additive.)
PREGNANCY: There are no adequate studies in
pregnant women. Gold sodium
thiomalate should be used during pregnancy only if the potential benefit to the
mother justifies the potential risk to the fetus.
NURSING MOTHERS: Gold sodium thiomalate has been found in the
breast milk of
nursing mothers. Due to the potential for serious adverse reactions in nursing
infants, decisions should be made whether to discontinue nursing or to
discontinue the drug.
SIDE EFFECTS: The most common adverse reaction gold sodium thiomalate is
dermatitis (skin inflammation), pruritus (itching), stomatitis (inflammation
affecting the structures in the mouth such as cheeks, gums, tongue, lips,
throat). Because gold sodium thiomalate can cause serious kidney and bone marrow
problems, all patients require regular monitoring with blood and urine tests.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count. Treatment of Felty's syndrome is not always required; however, treatment for patients with infections is available.
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