Indications: severe active or progressive rheumatoid arthritis; palindromic rheumatism, juvenile chronic arthritis (Still's disease).

Cautions: patients should report any untoward symptoms (fever, buccal ulceration, purpura, epistaxis, bleeding gums, menorrhagia diarrhoea, metallic taste, sore throat, malaise, bruising). cautions in renal and hepatic impairment, elderly patients, eczema, colitis breast- feeding; treatment with drugs which can cause blood disorders; annual chest x-ray recommended.

Contra-indications: severe renal and hepatic disease; history of blood disorders or bone marrow aplasia, exfoliative dermatitis, systemic lupus erythematosus, necrotizing enterocolitis, pulmonary fibrosis; pregnancy; porphyria.

Side Effects: Severe reactions, which could be fatal, mouth ulcers skin reactions, oedema, proteinuria, blood disorders; rarely colitis peripheral neuritis, pulmonary fibrosis, hepatotoxicity with cholestatic jaundice.

Dose: administered on expert advice, adults, dose must be given by deep IM. injection and the area gently massaged. It is usual to begin treatment with test dose of 10mg followed by doses of 50mg at weekly intervals until remission occurs or a total of 1 g has been given.

Benefit is not to be expected until about 8 doses (300- 500mg) have been given. The interval between injections is then gradually increased to 2 and then to 4 weeks but intervals of 6 weeks may be suitable in some patients and treatment is continued for 5 years after complete remission. If relapse occurs, dosage may be immediately increased to 50mg weekly and then reduced if control is obtained. It is important to avoid complete relapse since second courses of gold are not usually effective. Child, 1mg/kg weekly to a max. of 50mg weekly, the interval being gradually increased to 4 weeks according to response; an initial test dose is given which is equivalent to 1/10-1/5 of the calculated dose.