Dr. V. M. KAIKINI

USE OF GOLD PREPARATIONS INRHEUMATOID ARTHRITIS

By

Dr. V. M. KAIKINI, B.A., F.R.C.S. (Edin)
Consulting Surgeon, K.E.M. Hospital
BOMBAY

The Antiseptic, Madras-Jan. 1953.

 

     The term rheumatism is so indiscriminately used for cases of arthritis that it is very often dif­ficult to know the specific variety to which the disease belongs. Thus, all varieties of arthritis acute or chronic due to rheumatic fever, syphilis, gonorrhea, hemophilia, sepsis and osteo-arthritis or rheumatoid arthritis are clas­sified under the term ‘rheumatism’. To be pre­cise and accurate the term ‘rheumatism’ should be applied only to rheumatic fever which is an acute polyarticular disease in which usually the larger joints get involved one at a time, the others following in succession. Recurrence aftersubsidence of the trouble is common, ac­companied by pathological changes in the heart.

The most common non-specific varieties of arthritis are osteo-arthritis and rheumatoid ar­thritis. Osteo-arthritis is a chronic mono-articu­lar disease and occurs most commonly in el­derly people - the larger joints, especially the hip joint or shoulder joint being involved. It gives rise to pain at the beginning, followed by rigidity in later stages. Swelling is late in appearing. It is an intra-articular disease involving the cartil­ages and bones of the joint, with hypertrophyand cause locking of the joint, with restriction of movements. Much more common is rheumatoid arthritis. Osteo-arthritis is definitely a disease of degeneration of the body tissues due to old age. But rheumatoid arthritis occurs most commonly in young adults and even in small children, it is an acute and mostly a polyarticular disease. Sometimes it is mono-ar­ticular also. Most likely it is a disease due to some disturbance in metabolism as on special etiological factor can be detected. Nowadays, more cases of this diseases are found than it used to be some years ago. It is probably due to the lack of the elements of nutrition in the food that we have been getting now, especially the absence of the necessary amount of milk, milk- products etc., in our diet.

In the typical variety in young adults, it oc­curs as an acute polyarticular type, with pain and swelling, begining first in the smaller joints, usually of the fingers. After some time the bigger joints are affected.Fever may be pre­sent in some cases at the begining : in the majority of cases it is however, absent. But pain and swelling are well marked. This variety runs a persistent and prolonged course and may ulti­mately cripple the patient.

Lately the majority of cases that come under observation have been of the mono-articular type, the trouble occurring in the larger joints especially of the lower extremity, the knee joint being the most affected, other joints becoming affected later on. The disease runs a compara­tively mild course in the majority of cases al­though pain and rigidity are present, causing a great deal of inconvenience to the patient. Con­stitutional symptoms like fever and debility which are common in the other variety are usu­ally absent. On the whole this variety runs a mild course although recurrence is common. But permanent disability is rare. In young chil­dren the acute polyarticular variety of rheumatoid arthritis occurs in a more serious form, the smaller joints being involved first, the bigger joints following later. Constitutional symptoms like fever, debility is a marked fea­ture. This variety is called Still’s disease and is luckily comparatively rare.

In the milder type in adults described above, the usual remedies like salicylates very often give relief but in the majority of cases other re­medies have to be tried. Hydrotherapy has been found very useful in many cases espe­cially sea bathing. This should be supplemented by massage and internal re­medies. Irgapyrine injections have been found to give relief in some cases. But very good re­sults have been obtained with remedies con­taining gold products like myocrisin. Recently I tried Rheumophan Tablets of Alarsin Co., con­taining Gold Bhasma and Guggul which gave exceedingly good result in many cases of rheumatoid arthritis of the above variety. This was tried in about twenty-five cases, the majority of them being early ones.

In the mono-articular type the results were rapid, the swelling and pain disappeared within a week and the recurrence, if it occurred, was very mild. One was a typical case of rheumatoid arthritis in a woman aged  about 23 years. The trouble was of recurring type. Very good results were obtained by the use of these tablets. Both gold and guggul have been used foe centuries in Ayurvedic medicine for the treatment of arthritis.

The tablets were only once tried in a very chronic and persistent case. The patient had ar­thritis trouble-polyarticular-of many years dura­tion with all the constitutional symptoms of rheumatoid arthritis. The tablets were tried for about two months but only slight, improvement was noticed in a very chronic case of long dura­tion a prolonged course of treatment was necessary in this case.

I obtained very good results by the intraven­ous injections of ¹/2 c.c. of diluted antityphoid vaccine in a fairly advanced case of rheumatoid 'arthritis. But the reaction after the injection was very severe with high temperature and other constitutional symptoms. Myocrisin also gives rise to some reaction, though mild when given in graduated doses. But gold and guggul given by mouth produce no after-effects at all and the results are good. Being a restorative, gold improves general health and acts as a tonic also.

Before staring treatment, the underlying cause of arthritis should be correctly ascertained, eliminating rheumatic fever, syphilis and gonorrhea etc. which are also other likely factors. This gold therapy has not so far been tried in cases other than rheumatoid arthritis. In view of the therapeutic value of its constituents, Rheumophan, deserves to be given a trial in such other cases also.