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.