Gold therapy seems to be a safe treatment option for severe rheumatoid arthritis in both pregnant women and women who are trying to conceive who must discontinue or forgo other teratogenic therapies, according to findings from a small chart review.
The study looked at 14 women with severe rheumatoid arthritis (RA) who became pregnant while taking gold between January 1992 and January 2006. One woman had stopped taking gold therapy 4 weeks prior to conception; four women stayed on gold throughout the pregnancy.
The 14 women reported 20 pregnancies, according to Dr. Mohammed Almarzouqi, a rheumatologist at the University of British Columbia, Vancouver, and his fellow researchers.
Rheumatoid arthritis was considered controlled if there were fewer than four swollen or tender joints in an assessment by a clinic rheumatologist, and if no new prescription of prednisone or nonsteroidal anti-inflammatory drugs was required.
The mean age at pregnancy was 35 years (range 24–41) and the mean disease duration was 8.5 years. Rheumatoid factor was positive in 9 of 14 women.
The amount of time taking gold prior to conception was less than 1 year in seven pregnancies, 1–2 years in four pregnancies, 25–34 months in two pregnancies, and 2–8 years in seven pregnancies. Six of the patients had 11 pregnancies prior to gold therapy.
Ten patients had never taken methotrexate (MTX) prior to conception, while the other four women had discontinued MTX 8–16 months before conception. Thirteen pregnancies had a mean dose of gold while planning pregnancy and prior to conception of 25–50 mg/week. At the high end of the dosage spectrum, two pregnancies followed a dose of 50 mg/every 2 weeks, and in one pregnancy it was 60 mg/week.
At the low end, two pregnancies had a mean dose of 5–10 mg/week, and two other pregnancies had a mean dose of 10 mg every 2 weeks (J. Rheumatol. 2007;34:1827-31).
“In our small series of women taking gold for RA while planning pregnancy, 5 of 20 pregnancies ended in spontaneous abortion,” wrote the investigators.
However, they pointed out that the mean age of women in their study was 35 years, and that the rate of fetal loss in women over 40 and women near that age is higher than for younger women.
Additionally, two of the reported spontaneous abortions occurred in a woman with a “known chromosomal defect.” Two of the women who lost a fetus also reported birth of one healthy baby while taking gold.
The remaining children, including one set of twins, were healthy at birth.
Rheumatoid arthritis flared during just 3 of the 15 full-term pregnancies, and it was controlled in the rest.
Although this study was small, the authors concluded that, in light of the fact that there are so few available disease-modifying antirheumatic drugs that are recommended for pregnant women or women attempting pregnancy, gold is a safe and efficacious rheumatoid arthritis treatment during pregnancy.
The investigators disclosed no conflicts of interest related to this study.