1. Eighty patients with active, advanced rheumatoid arthritis, which was refractory to other therapeutic measures, received injections of gold salts. Thirty-five patients (43.75 per cent.) were markedly improved and thirty-one (38.75 per cent.) were moderately or slightly improved,-a total of sixty-six patients, or 82.5 per cent., who were improved to some extent. Fourteen patients (17.5 per cent.) experienced no improvement. Of eleven patients with ankylosing spondylitis, six (54.55 per cent.) were improved, and five (45.45 per cent.) were unimproved. The results of gold therapy in these cases were inferior to those obtained in cases of rheumatoid arthritis with involvement of the peripheral joints.
2. Local and systemic reactions occurred in nineteen (23.75 per cent.) of our cases. The commonest were pruritis, urticaria, and stomatitis. In three cases treatments were discontinued on account of severe reactions. In the others the reactions were mild, and treatments were stopped until the toxic symptoms cleared up, and were then resumed. Severe toxic reactions, purpura, and death have been reported in the literature.
3. Gold therapy is contra-indicated in the presence of renal or hepatic diseases, asthma, urticaria, diabetes, pregnancy, granulopenia, purpura, thrombopenia, and primary and severe secondary anaemia.
4. Gold therapy is indicated only in cases of rheumatoid arthritis. The high percentage of marked improvement, the moderate occurrence of relapses, and the efficiency even after prolonged duration of the disease establish gold salts as a valuable treatment of rheumatoid arthritis. We concur with the opinion of other workers that it is superior to any treatment which we have to date. On the other hand, the considerable percentage of unsatisfactory results and the occurrence of toxic reactions lead to the conclusion that gold therapy, while a decided step forward, is still not the ideal treatment for rheumatoid arthritis.
(C) 1939 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.