Gold Sodium Thiomalate

INTRODUCTION

Indications

Progressive rheumatoid arthritis resistant to conventional therapy.

Action

Inhibits inflammatory process. Modifies immune response (immunomodulating properties). Therapeutic Effects: Relief of pain and inflammation. Slowing of the disease process in rheumatoid arthritis.

Adverse Reactions/Side Effects

CNS: dizziness, headache, neuropathy, syncope. EENT: corneal gold deposition, corneal ulcerations. Resp: pneumonitis. CV: bradycardia. GI: abdominal pain, cramping, diarrhea, metallic taste, stomatitis, anorexia, difficulty swallowing, drug-induced hepatitis, dyspepsia, flatulence, nausea, vomiting. Derm: dermatitis, rash, photosensitivity reactions, pruritus. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, thrombocytopenia, eosinophilia, leukopenia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, angioneurotic edema, nitritoid reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of allergic reactions, including anaphylaxis and angioneurotic edema. Signs include pulmonary symptoms such as tightness in the throat and chest, wheezing, cough, and dyspnea, and skin reactions such as rash, pruritus, urticaria, burning/itching skin, and swelling in the face. Notify physician immediately if these reactions occur.

• Monitor and report signs of agranulocytosis (fever, sore throat, mucosal lesions, infection), aplastic anemia (unusual fatigue, shortness of breath with exertion), thrombocytopenia (bruising, nose bleeds, bleeding gums), or other weakness or coagulation problems that might indicate other blood dyscrasias. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Be alert for reactions resembling nitrite poisoning (nitritoid reactions), including flushing of the face, edema of the tongue and lips, vomiting, profuse sweating, and hypotension. Seek immediate medical assistance because these reactions can be severe and life threatening.

• Assess any breathing problems or signs of pneumonitis such as dry cough, wheezing, rales, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Assess heart rate and ECG, especially during exercise (See Appendix G). Report bradycardia or symptoms of arrhythmias, including chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess dizziness and syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for signs of peripheral neuropathy such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

Interventions

• Implement appropriate manual therapy ...