Sodium Aurothiomalate For Arthritis: Expectations And Safety
Comprehensive guide to sodium aurothiomalate injections for managing rheumatoid arthritis symptoms and progression.
Sodium aurothiomalate, also known as gold sodium thiomalate or Myocrisin, is a disease-modifying antirheumatic drug (DMARD) used to treat active rheumatoid arthritis in both adults and juveniles.
About sodium aurothiomalate
| Type of medicine | Also called | Available as |
|---|---|---|
| Disease-modifying antirheumatic drug (DMARD) | Gold sodium thiomalate (US); Myocrisin® (discontinued) | Intramuscular injection |
Rheumatoid arthritis (RA) is an autoimmune condition where the immune system attacks the body’s own tissues, particularly the joints, leading to inflammation, pain, and potential structural damage. Sodium aurothiomalate works by suppressing the immune system, reducing the production of antibodies that harm joint tissues, and inhibiting prostaglandin synthesis, which contributes to synovitis suppression.
Also referred to as ‘gold therapy,’ it is most effective in early active stages of RA, where it can halt disease progression and prevent further joint damage, though it cannot reverse existing cartilage or bone destruction. Therapeutic effects build gradually, often taking 2-6 months to fully manifest, with initial improvements like reduced morning stiffness appearing after 6-8 weeks.
It is administered only as part of a comprehensive treatment plan including rest, physiotherapy, and other medications, not as standalone therapy.
How are sodium aurothiomalate injections given?
Sodium aurothiomalate is given exclusively by deep intramuscular injection, preferably into the gluteal muscle, by a specialist doctor or nurse in a clinic setting. Patients must lie down during administration and remain recumbent for about 10 minutes afterward to minimize side effects like dizziness.
Prior to starting, patients receive the manufacturer’s patient information leaflet detailing the drug and potential side effects. A
test dose
of 10 mg is mandatory for first-time users to assess tolerance before proceeding to standard doses.Typical dosage regimen:
- Test dose: 10 mg (in secondary care).
- Weekly injections: 50 mg until response or cumulative 1000 mg reached.
- Maintenance: Gradually extend intervals to every 2, 3, then 4 weeks (25-50 mg), potentially indefinitely if stable.
- If no improvement after 1 g cumulative dose, consider alternatives.
Absorption is rapid post-IM injection, with peak serum levels in 3-6 hours. In responders (60-70% of patients), continue indefinitely absent toxicity; full response may take 3 months (400-600 mg total).
Many patients use anti-inflammatory painkillers initially until DMARD effects kick in, then taper as symptoms improve. Painkillers manage symptoms but do not modify disease progression.
Missed doses: Contact clinic promptly to reschedule; regular injections are crucial.
How does it work?
The precise mechanism remains unknown, but sodium aurothiomalate exerts immunosuppressive effects, suppressing synovitis in active RA and inhibiting prostaglandin synthesis. It reduces immune-mediated joint inflammation, preventing further damage in progressive cases, though ineffective for severe deformities or other arthritis forms.
Gold levels in blood, plasma, and hemolysate are monitored during therapy to correlate with efficacy and toxicity.
Before having sodium aurothiomalate injections
Inform your doctor of:
- Allergies, especially to gold or previous reactions.
- Kidney/liver issues, eczema, urticaria, inflammatory bowel disease (extra caution needed).
- Pregnancy/breastfeeding: Avoid; not recommended.
- Current medications, as interactions may occur.
Blood and urine tests: Mandatory baseline and regular monitoring (e.g., weekly initially, then per schedule) for blood counts, kidney/liver function, proteinuria to detect toxicity early.
How to use other medicines safely with sodium aurothiomalate
Combine with:
- NSAIDs or analgesics for symptom relief.
- Other DMARDs under supervision, but monitor closely.
- Avoid live vaccines; caution with penicillamine or other gold compounds.
Regular clinic visits ensure safe polytherapy.
Cautions when having sodium aurothiomalate injections
- **Skin sensitivity:** Increased photosensitivity; use high-SPF sunscreen, avoid sunbeds/excessive sun.
- **Driving:** Possible dizziness post-injection; do not drive until recovered.
- **Elderly/renal-hepatic impairment:** Extra monitoring.
- **Nitritoid reactions:** Facial flushing, dizziness possible after injections; lie down if occurs.
Side-effects of sodium aurothiomalate injections
Common: Dermatitis, pruritus, rash, proteinuria, stomatitis. Serious risks include:
- Blood dyscrasias (thrombocytopenia, pancytopenia, aplastic anemia); discontinue if suspected.
- Nephrotoxicity (proteinuria >500 mg/24h); stop and refer.
- Rash: Itchy/erythematous; manage with antihistamines/steroids, but discontinue if severe.
- Other: Metallic taste, diarrhea, cholestatic jaundice.
Black Box Warning: Severe toxicities like renal failure, blood disorders; monitor closely.
Report any new symptoms immediately; temporary dose reduction or steroids may control mild issues.
Understanding your treatment
Expect gradual improvement; track symptoms. If exacerbating, resume weekly doses temporarily. After 1000 mg without benefit, switch DMARDs. Long-term use possible in responders.
Stop taking sodium aurothiomalate injections
Do not stop without consulting; abrupt halt may worsen RA. Taper under supervision if discontinuing due to toxicity/non-response.
Non-medical treatment for rheumatoid arthritis
Complement with:
- Physiotherapy/exercise to maintain joint mobility.
- Balanced diet, weight management.
- Splints, occupational therapy.
- Rest during flares.
Frequently Asked Questions
Q: How long until sodium aurothiomalate works?
Improvement starts in 2-3 months (400-600 mg), full effects 2-6 months.
Q: Is a test dose always needed?
Yes, 10 mg test dose for new patients to check tolerance.
Q: Can it reverse joint damage?
No, it prevents further damage but doesn’t repair existing harm.
Q: What if I miss an injection?
Contact clinic ASAP to reschedule.
Q: Is monitoring required?
Yes, blood/urine tests weekly initially, then less frequently.
Q: Suitable for children?
Yes, for juvenile RA, dosed appropriately.
References
- Sodium aurothiomalate – wikidoc — WikiDoc. Accessed 2026. https://www.wikidoc.org/index.php/Sodium_aurothiomalate
- Sodium Aurothiomalate. Myocrisin for arthritis – Patient.info — Patient.info. Accessed 2026. https://patient.info/medicine/sodium-aurothiomalate-for-arthritis
- Sodium aurothiomalate: Uses, Interactions, Mechanism of Action — DrugBank. Accessed 2026. https://go.drugbank.com/drugs/DB09276
- Gold levels produced by treatment with auranofin and sodium aurothiomalate — PubMed (Peer-reviewed). 1983-10-01. https://pubmed.ncbi.nlm.nih.gov/6414387/
- Sodium aurothiomalate (gold therapy) rheumatology local safety — Shropshire Telford and Wrekin CCG (NHS). 2018-03. https://www.shropshiretelfordandwrekinccg.nhs.uk/wp-content/uploads/gold-sodium-aurothiomalate-gold-therapy-rheumatology-sca-v12b-march-2018.pdf
- Sodium Aurothiomalate_CV19 — WMIC Wales NHS. 2023-09. https://www.wmic.wales.nhs.uk/wp-content/uploads/2023/09/Sodium-Aurothiomalate-CV-19.pdf
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