Postmortem specimens from a patient with rheumatoid arthritis who had received 5 g of aurothioglucose were examined histologically, and their gold content was determined by activation analysis. The highest concentration of gold was found in the lymph nodes followed by the adrenal gland, renal cortex and other organs of the reticuloendothelial system. Comparatively low concentrations were found in tissues comprising the joint structure. Organs in which the greatest quantities of gold were stored include the bone marrow, liver, skin and bone. These findings demonstrate the body's capacity to store relatively large quantities of gold without adverse reaction, support the concept of a systemic rather than local mechanism of action (at the joint level) and demonstrate in vivo gold concentrations in the range expected to produce local cellular biologic effects.The metabolic and excretory pathways of gold compounds have been of interest to investigators since their benefit in the treatment of rheumatoid arthritis was first reported more than 40 years ago (1). Abundant data are available regarding gold concentrations in blood and its components and in the urine and feces of human and experimental animal models (2-6). T' issue distribution of gold, on the other hand, has been adequately studied only in animals (7,8) Submitted for publication Apr 6, 1971; accepted June 21, 1971. tissues has never been systematically measured. There are scanty reports of gold levels in human skin, synovium, synovial fluid, etc, but methods of gold analysis were relatively insensitive and some of the patients studied had received only one injection of a radioactive gold-labeled compound rather than a course of gold therapy (2,3,9,10). No information is available regarding gold concentrations in internal organs or in the musculoskeletal system of a patient with rheumatoid arthritis on longterm chrysotherapy. The sudden death of such a patient afforded us the opportunity to analyze tissues for their gold content.
CASE REPORTMV was a 68-year-old white female with classic rheumatoid arthritis, by the ARA criteria. of 16 years duration who died in November 1969, of an overdose of barbiturate. When first seen in the Arthritis Clinic at Jackson Memorial Hospital in June 1958, she related a 5-year history of progressive polyarthritis with morning stiffness. Physical examination showed active synovitis of metacarpal phalangeal and proximal interphalangeal joints,
16Arthritis and Rheumatism, Vol. 15, No. 1 (Januafy-FebrurIy 1 9 n )