The juxtaposition of the old and the new was readily evident that busy Wednesday morning. My first patient, a 94-year-old gentleman, Hal, arrived with a precise request. His rheumatologist for the past 40 years had just retired, and he was searching for a doctor with expertise in the use of gold sodium aurothioglucose, the drug that had driven his rheumatoid arthritis (RA) into remission decades before.
Explore this issueDecember 2017
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Whether it was based on fact or superstition, we were taught that if gold induced a state of low disease activity, it should never be stopped. The lucky few patients who achieved remission would return monthly for their injections, ad infinitum.
Hal described the marvelous benefits of gold, and he was mystified as to why this “wonder drug” had become so difficult to procure. Although he located a pharmacy that sold an injectable gold salt product, it was of a different variety, gold sodium thiomalate (GST), a formulation that caused him great distress, with symptoms of nausea and flushing following each injection, reminiscent of the irksome nitritoid reaction, a well-recognized side effect of chrysotherapy that occurred in roughly 5% of patients taking GST.1| | | Next → | Single Page