Nonetheless, some patients who have been unable to take methotrexate and the newer biologic agents remain on gold therapy. As one speaks to practicing rheumatologists, many have one or two patient still on gold therapy. While Solganal was the preferred agent in these patients, in 1998 Schering Plough and the Food and Drug Administration entered into a dispute over the manufacturing process for this agent. In May 2002, a business decision was made by the company to discontinue the manufacture of Solganal. Myochrysine and auranofin are still on the market, but are rarely used.
Thus gold, once a very promising agent in the treatment of RA, has fallen into disuse with the approval of new agents that are both more efficacious and less toxic. There is still a very small market for this drug, however, particularly in patients who are unable to take methotrexate or cannot afford the biologic agents. Unfortunately, the choice of gold agents is now restricted by the manufacturers.
Gold has an important history in the treatment of rheumatic disease. It was the first agent to be proved to have a true disease-modifying effect and to be studied prospectively in a double-blind, controlled trial. This history holds many important lessons for us today.
Dr. Gall is professor of clinical medicine and interim director of the Arizona Arthritis Center at the University of Arizona in Tucson. He has no relevant financial interests to disclose.