title: Characterization of patients with arthritis referred for gold therapy in the era of biologics.
abstract: OBJECTIVE
  To describe the clinical characteristics of patients referred for gold therapy and determine the reason for referral.
  
  
  METHODS
  We conducted a chart review of patients referred for gold at the Mary Pack Arthritis Program, Vancouver, Canada, from July 2007 to July 2009.
  
  
  RESULTS
  The sample included 69 female and 12 male patients. Diagnosis was rheumatoid arthritis (RA) in 71/81, psoriatic arthritis in 5, juvenile idiopathic arthritis (JIA) in 2, Sjögren syndrome in 1, undifferentiated polyarthritis in 1, and spondyloarthritis in 1. Twenty of 81 patients had received gold before: 15 were referred for a second course, 4 a third course, and 1 a fourth course. Ten of 81 patients were referred for gold as their first disease-modifying antirheumatic drug (DMARD). Seventy-one had received prior DMARD: 1 prior DMARD in 22 patients, 2 in 24 patients, 3 in 15 patients, and > 3 in 6 patients. Four patients had received prior biologic therapy plus 2 to 4 prior DMARD. Twelve of 71 received gold monotherapy, 56/71 received gold/DMARD combinations, and 3 received gold/biologic/DMARD combinations. Reasons for referral included failure of other DMARD in 54 patients, limited DMARD options in 50 (chronic liver disease in 34, sulfa allergy in 7, high alcohol consumption in 5, and planning pregnancy in 4), physician choice in 12, previous benefit from gold in 10, benefit of clinic support in 10, inappropriate for biologics in 7, patient choice in 4, and failure of biologics in 3.
  
  
  CONCLUSIONS
  The most common reasons for referral to gold clinic in 2007 to 2009 are failure of other DMARD and limited DMARD options due to underlying liver disease.
authors.affiliation: Mary Pack Arthritis Centre, 895 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Cheung
authors.forename: Debra
authors.initials: D
authors.lastname: Scarsbrook
authors.forename: Alice V
authors.initials: AV
authors.lastname: Klinkhoff
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy* / Q000453:epidemiology; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000453:epidemiology; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology; D000075202:Contraindications; D005260:Female; D006052:Gold Sodium Thiomalate / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012859:Sjogren's Syndrome / Q000188:drug therapy / Q000453:epidemiology; D025241:Spondylarthritis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D006052:Gold Sodium Thiomalate