[Indications and contraindications for systemic gold therapy]

At the current state of the art a comparison of gold salts and other therapeutic modalities in terms of their risk-benefit ratios clearly shows chrysotherapy to have a place in the treatment of active rheumatoid arthritis. Factors supporting the use of gold salts as base-line drugs for active rheumatoid arthritis include the extensive experience accumulated with chrysotherapy as a basic antirheumatoid treatment and the potential of gold salts to halt joint destruction. The application of gold salts in the treatment of juvenile chronic polyarthritis and psoriatic arthritis rests on the same rationale. Further studies are needed to establish the place of gold salts in ankylosing spondylitis and chronic Reiter's syndrome. Contraindications include diseases of organs likely to be the site of disastrous side effects on gold administration as well as disseminated lupus erythematosus and arthritis in the presence of colitis. Experiences with systemic gold therapy will, no doubt, be expanded in many a respect by the availability of an oral dosage form. Whatever the indication of gold salts a thorough understanding of clinical rheumatology, a complete mastery of the technique and consistent, meticulous patient monitoring are paramount if treatment is to be beneficial.