ANTIARHRITIC DRUGS
Antiarthritic drugs include gold compounds that prevent and suppress arthritis in selected
patients with rheumatoid arthritis and other anti-arthritis drugs that help block the
inflammation and tissue damage of rheumatoid arthritis.
Therapeutic Action
Indications
Pharmacokinetics
Contraindications and Cautions
Adverse Effects
Interactions
Nursing Considerations
Antiarthritic Drugs: Generic and Brand Names
Here is a table of commonly encountered immune system drugs, their generic names, and brand
names:
Classification Generic Name Brand Name
auranofin Ridaura
Gold Compounds
gold sodium thiomalate Aurolate
anakinra Kineret
etanercept Enbrel
Other Agents hyaluronidase derivatives Synvisc
penicillamine Depen
sodium hyaluronate Hyalgan
Disease Spotlight: Arthritis
Arthritis is a group of more than 100 types of joint pain or disease and related
conditions involving an inflammatory process in the joints which can cause pain and
bone It affects people of all ages, sexes, and races. It is the leading cause of disability
in America.
Symptoms include swelling, pain, stiffness, and decreased range of motion. Over
time, this will lead to permanent joint changes.
NSAIDs are often used in rheumatoid arthritis (an autoimmune disorder affecting the
small joints) and osteoarthritis (arthritis of the weight-bearing joints common in older
people).
Gold Compounds
Gold salts treatment (chrysotherapy) is indicated for patients with rheumatic
inflammatory conditions who do not respond to the usual anti-inflammatory therapies.
Chrysotherapy involves macrophages taking up gold which then inhibit
phagocytosis.
Therapeutic Action
The desired and beneficial action of gold compounds is:
Inhibition of phagocytosis and release of lysosomal enzymes leading to inhibited
tissue destruction. This action allows gold salts to suppress and prevent some arthritis
and synovitis.
Indications
Gold compounds are indicated for the following medical conditions:
Treatment for selected cases of rheumatoid and juvenile rheumatoid arthritis in
patients whose disease have been unresponsive to standard therapy. However, they
only prevent further damage and so are most effective if used early in the disease.
Auranofin is an oral agent for long-term therapy of rheumatic disorders.
Gold sodium thiomalate is an injected drug for early treatment of rheumatic
disorders.
Pharmacokinetics
Here are the characteristic interactions of gold compounds and the body in terms of absorption,
distribution, metabolism, and excretion:
Route Onset Peak Duration
Oral Slow 4-6 h –
T1/2: 3-7 days
Metabolism: –
Excretion: urine and feces
Contraindications and Cautions
The following are contraindications and cautions for the use of gold compounds:
Any known allergy to gold
Severe diabetes
Congestive heart failure
Severe debilitation
Renal or hepatic impairment
Hypertension
Blood dyscrasias
Recent radiation treatment
History of toxic levels of heavy metals
Pregnancy or lactation
Adverse Effects
Use of gold compounds may result to these adverse effects:
Skin: dermatitis, pruritus, exfoliative dermatitis, allergic reactions ranging from
flushing, fainting, and dizziness to anaphylactic shock
GI: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, other GI
inflammation
Respiratory: gold bronchitis, interstitial pneumonitis
Hema: bone marrow depression
GU: vaginitis, nephrotic syndrome
Interactions
The following are drug-drug interactions involved in the use of gold compounds:
Penicillamine, antimalarials, cytotoxic drugs, immunosuppressive agents: potential for
severe toxicity
Nursing Considerations
Nursing considerations for patients receiving antiarthritics are similar to those for patients
receiving nonsteroidal anti-inflammatory drugs and related agents.
