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Going for Gold

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Gold shimmers, attracts and has always been relatively expensive. This led people to believe that it must have mystical curative properties. Gold therapy was popular. It was given for arthritis, psoriasis, asthma and sexually transmitted diseases in the form of orally administered gold salts. It was and is still used in several ancient systems of medicine.Gold therapy is effective in rheumatoid arthritis

Eventually, as scientific evidence-based medicine gained popularity, the use of gold fell into disrepute. It did not work in all forms of arthritis. It had no effect on some of the other diseases mentioned. In fact, unless the dosage was carefully controlled, gold accumulated in the body and produced itching, skin pigmentation, pneumonia, jaundice and kidney failure. Today, however, the use of gold has resurged and it is effective when used in rheumatoid arthritis (RA).

Some 10 million Indians, 70 per cent of whom are women between the ages 30 and 50, are affected by RA. The disease strikes suddenly; an active person unexpectedly develops excruciating pain and is unable to move. The joints are affected symmetrically on both sides of the body, with the smaller ones in the hands and feet affected first. There is redness, swelling and pain. The person often has other vague accompanying symptoms like low-grade fever, loss of weight, tiredness and some nodular swellings under the skin.

For some strange reason, in these individuals, the immune system goes haywire. The white blood cells (responsible for attacking foreign particles like disease-causing bacteria and viruses) focus on the synovial membrane lining the joints instead. The synovium responds by becoming inflamed and thickened. It damages, distorts and destroys the bone and cartilage. Eventually, the joint loses its shape, becomes misaligned and may be destroyed.

A viral or bacterial infection may precipitate the arthritis. There may be a familial predisposition. Some of these individuals carry the HLA DR4 gene. The precipitating factors are not consistent. The disease probably occurs in genetically predisposed individuals when the correct mix of environmental and lifestyle factors occur. In most people no cause can be found.

RA cannot be confirmed on the basis of a single blood test. The diagnosis is suspected based on the clinical features. Blood tests showing anaemia, a high ESR (erythrocyte sedimentation rate), a positive rheumatoid factor and positive anti-cyclic citrullinated peptide (anti-CCP) antibodies help support the diagnosis.

The diagnosis has to be differentiated from osteoarthritis (OA), a distinctly different disease which occurs asymmetrically in the large joints of older individuals. The treatment of OA is also quite different.

Treatment of rheumatoid arthritis is a challenge. Before the advent of newer medication the disease eventually left its sufferers crippled and confined to wheelchairs. The disease itself tends to wax and wane inexplicably, with many exacerbations and remissions, requiring a lifetime of pain and mobility management. Today, a holistic approach has been found to work best. Rest is advocated during the exacerbations. Activity is graded and slowly increased during periods of remission. In addition to traditional physiotherapy, yoga and Tai-Chi exercises help to keep the joints supple and mobile.

External applications of capsaicin-containing ointments provide efficacious counter irritation (Capsaicin is a chemical found in green peppers or capsicum). This can be combined with alternating heat and cold therapy. Splints can be used to keep the joints aligned and reduce pain.

Effective medication is now available. This belongs to several groups, like the non steroidal anti inflammatory agents (NSAIDs), disease modifying anti rheumatic drugs (DMARDs), steroids, immunosuppressive drugs and “newer” medication like leflunomide. The drugs take a minimum of two weeks to act. Dosages have to be slowly increased to the maximum permissible and tolerated level before adding new medicines and switching drugs.

Gold compounds do slow the progression of RA. They are usually given in increasing weekly increments keeping a tab on the total quantity administered. This means that the maximum permissible amount (1gm) is not exceeded. The dose then has to be tapered. A careful watch has to be kept for serious side effects like bone marrow suppression, kidney and renal failure.

Unfortunately, gold is being widely unethically advertised and administered to unsuspecting patients for the treatment of all kinds of arthritis and even to curb the vague aches and pains of ageing. These “health supplements” contain unregulated quantities of the metal in capsules or as a thick syrup. Sometimes extra gold is added for the wealthy. The presence of the gold maybe disguised and called by derivatives of the Latin name “aurium” or the Hindi “sona”.

Eventually slow undiagnosed fatal toxicity or reactions with other medication can occur.

Check all medication before using it. Do not “go for gold” without asking your doctor.

Sources: The Telegraph (Kolkata, India)

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