Gold injections (Myocrisin)

What are gold injections?

Gold injections (Myocrisin™) are a compound called sodium aurothiomalate which contains gold. They belong to a group of drugs known as disease-modifying anti-rheumatic drugs (DMARDs). These drugs dampen down the underlying disease process, rather than simply treating your symptoms.

Gold reduces the activity of your immune system, so it's always used with care.

Please note, this text was last revised in November 2013.

Uses

Gold is prescribed to reduce joint inflammation and slow down the disease process that can lead to joint damage and deformity in rheumatoid arthritis. Sometime gold is also used to treat other auto-immune conditions, such as psoriatic arthritis.

In rheumatoid arthritis and other inflammatory types of arthritis, the body's immune system is overactive, attacking the body's own tissues. Disease-modifying anti-rheumatic drugs (DMARDs) such as gold work by reducing the activity of the immune system.

Is there any reason I won't be prescribed gold?

Gold won't usually be prescribed if:

  • you have severe kidney or liver problems
  • you have lupus
  • you're pregnant or breastfeeding
  • you've had a blood or bone marrow disorder
  • you've ever had an itchy, red, scaly skin condition called exfoliative dermatitis.

Usually your doctor will recommend you have a small test dose before starting gold injections to make sure you don't have an immediate allergic reaction to them. You should tell the doctor if you feel faint or unwell, your lips or tongue swell or you develop a skin rash after the test dose as gold may not be the right treatment for you.

Please note, this text was last revised in November 2013.

How are they taken?

Gold is always given by intramuscular injection (an injection into a muscle), usually the buttocks. The injections can be given either at your GP's surgery or at the hospital.

The usual dose is 50 mg weekly to start with, until you've received a total dose of 1 g. If there is no sign of improvement in your condition after this your doctor will stop the gold injections and suggest a different treatment for you.

If gold injections work for you, your doctor may be able to reduce the dose or give it fortnightly or monthly instead. Some people carry on using gold for many years – how often the injections are given can be adjusted depending on how severe your symptoms are.

How long do they take to work?

Gold injections don't work immediately. It may be 3 months before you notice any benefit.

Please note, this text was last revised in November 2013.

Side-effects and risks

Gold injections can cause problems with your blood, kidneys or skin. You should tell your doctor or rheumatology nurse immediately if you develop any of the following after starting gold injections:

  • a sore throat
  • diarrhoea
  • a fever
  • any other symptoms of infection
  • bruising or bleeding
  • a rash
  • breathlessness
  • mouth ulcers
  • altered taste
  • any other new symptoms or anything else that concerns you.

Rarely gold injections can cause chrysiasis, which is a permanent grey/blue skin discolouration. This only happens after long-term use. Very rarely, some people feel faint or have an allergic reaction after having a gold injection. After your first injection you'll be advised to wait in the clinic for 30 minutes before leaving to make sure that you're OK.

If you're on an ACE inhibitor (for example ramipril, captopril or lisinopril), which are used to treat high blood pressure and heart disease, you may be at a slightly increased risk of having an allergic reaction to gold injections. You should therefore tell your doctor or nurse if you're taking any of these drugs.

Please note, this text was last revised in November 2013.

Effects on other treatments

You can have all types of vaccinations, including live vaccines, while you're being treated with gold injections but it's recommended that you discuss this with your doctor first.

You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you’re having gold injections.

If you're on an ACE inhibitor or start one after you begin taking regular gold injections, you should discuss this with your doctor because of the increased risk of side-effects.

You should also be aware of the following points:

  • Gold isn't a painkiller. If you're already on non-steroidal anti-inflammatory drug (NSAID) or a painkiller you can carry on taking these as well as the gold injections unless your doctor advises otherwise. However, if gold injections work for you, you may be able to reduce your NSAIDs or painkillers after a time.
  • Don't take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

Alcohol

There's no particular reason to avoid alcohol while on gold injections, so it's fine to drink alcohol in moderation.

Fertility, pregnancy and breastfeeding

Gold injections aren't advisable during pregnancy. If you're planning a family or if you become pregnant while on gold injections you should discuss this with your doctor as soon as possible.

Breastfeeding isn't normally recommended if you're on gold injections. Small amounts of the drug may pass into your breast milk and could be harmful to your baby.

Please note, this text was last revised in November 2013.

What else should I know?

Are there any alternatives?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Your doctor or rheumatology nurse will discuss these other options with you.

Will I need any special checks while on gold injections?

Some of the side-effects of gold injections can be picked up at a very early stage by having regular blood and urine tests and checking for any sign of a rash. It's very important to have these checks before every injection.

You may be asked to keep a record booklet with your blood and urine test results, and you should bring this with you when you visit your GP or the hospital. Always make sure that this record booklet is up to date before having your next gold injection.

You must not have gold injections unless you're having regular checks.

Where can I find out more?

If you would like any further information about gold injections, or if you have any concerns about your treatment, you should discuss these with your doctor, rheumatology nurse or pharmacist.

Please note, this text was last revised in November 2013.