Gold salts for arthritis: how do they work?

Gold salts have been used for a long time to treat arthritis, although how it worked or more pertinently, if it worked, was unclear. Injecting gold salts for inflamed and swollen rheumatic joints took weeks to work and often had nasty side effects: rashes, mouth ulcers, impaired kidney function and sometimes bone marrow depression. My pharmacology professor in medical school taught us the only thing gold was good for as a drug was "itchy palm disease." Now the chief of rheumatology at Duke, DAvid Pisetsky, is telling us we shouldn't be so dismissive:

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"We scientists have really never understood why gold works. Now that we have a better handle on its action, we may be able to use that mechanism to create new and better gold-like drugs to treat arthritis."

Pisetsky had long been interested in a particular molecule, HMBG1, which provokes inflammation, the key process underlying the development of rheumatoid arthritis. HMBG1 is a dual-function molecule, which means that it behaves one way when it's inside the nucleus of a cell, and quite another way when it's released from the cell.

Pisetsky says that inside the nucleus, HMGB1 is a key player in transcription, the process that converts genetic information in DNA to its RNA equivalent. But when HMGB1 is released from the cell -- either through normal processes or cell death -- it becomes a stimulus to the immune system and enhances inflammation. (here and here). So a more efficient gold salt analog for rheumatoid arthritis might not be so wonderful.

Meanwhile, there's always itchy palm disease.