Antiarthritic 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.