Rheumatology Book

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Gold Therapy

Aka: Gold Therapy, Gold Injection, Oral Gold, Auranofin, Ridaura
  1. Indications (Replaced by Methotrexate)
    1. Rheumatoid Arthritis
    2. Seropositive Rheumatoid Arthritis
  2. Efficacy (replaced by Methotrexate)
    1. Response rate
      1. Injection: 75%
      2. Oral: 50-60%
    2. Slowest therapeutic response of DMARD (3-6 months)
  3. Adverse Effects
    1. Gold Injection
      1. Pruritic rash (20%)
      2. Stomatitis
      3. Proteinuria due to membranous nephritis (5%)
      4. Hematologic (1%)
        1. Leukopenia (more common)
        2. Thrombocytopenia
        3. Anemia (less common)
      5. Gold Pneumonitis (rare)
      6. Gold colitis (rare)
      7. Nitritoid Reaction (uncommon)
        1. Flushing and vasodilation
        2. Hypotension and Tachycardia
        3. Occurs 5-30 minutes after Gold Injection
    2. Oral Gold
      1. Diarrhea (common and may limit compliance)
      2. Dermatitis (less common than with injection)
  4. Monitoring
    1. Indications to hold Gold Therapy
      1. Urinalysis with >2+ Proteinuria
      2. Complete Blood Count with cell line depression
        1. Leukopenia
        2. Thrombocytopenia
        3. Anemia
    2. Gold Injection
      1. Urinalysis for Proteinuria
        1. Obtain with each injection
      2. Complete Blood Count (CBC)
        1. Obtain weekly with each injection for 8 weeks
        2. Obtain monthly while on weekly injections
        3. Obtain every 3 months while on monthly gold
    3. Oral Injection
      1. Complete Blood Count (CBC) every 3 months
      2. Urinalysis for Proteinuria every 3 months
  5. Dose
    1. Oral: 3 mg PO bid

Auranofin (C0004320)

Definition (NCI) An orally available, lipophilic, organogold compound, used to treat rheumatoid arthritis, with anti-inflammatory and potential antineoplastic activities. Auranofin interacts with selenocysteine residue within the redox-active domain of mitochondrial thioredoxin reductase (TrxR), thereby blocking the activity of TrxR. As a result, this agent induces mitochondrial oxidative stress leading to the induction of apoptosis. Furthermore, this agent strongly inhibits the JAK1/STAT3 signal transduction pathway, thereby suppressing expression of immune factors involved in inflammation. TrxR, overexpressed in many cancer cell types, inhibits apoptosis, promotes cell growth and survival and plays a role in resistance to chemotherapy; TrxR catalyzes the reduction of oxidized thioredoxin (Trx) and plays a central role in regulating cellular redox homeostasis.
Definition (MSH) An oral chrysotherapeutic agent for the treatment of rheumatoid arthritis. Its exact mechanism of action is unknown, but it is believed to act via immunological mechanisms and alteration of lysosomal enzyme activity. Its efficacy is slightly less than that of injected gold salts, but it is better tolerated, and side effects which occur are potentially less serious.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D001310
SnomedCT 391797008, 18002004, 387100001
English Auranofin, Gold, (1-thio-beta-D-glucopyranose 2,3,4,6-tetraacetato-S)(triethylphosphine)-, auranofin, Auranofin [Chemical/Ingredient], Auranofin - chemical (substance), Auranofin - chemical, Auranofin (product), Auranofin (substance), AURANOFIN
Swedish Auranofin
Czech auranofin
Finnish Auranofiini
Russian AURANOFIN, АУРАНОФИН
Polish Auranofina
Japanese アウラノフィン, オーラノフィン
Spanish auranofina (producto), auranofina (sustancia), auranofina, Auranofina
French Auranofine
German Auranofin
Italian Auranofina
Portuguese Auranofina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Ridaura (C0699923)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D001310
English ridaura, Auranofin Recordati Brand, Auranofin Yamanouchi Brand, Recordati Brand of Auranofin, SmithKline Beecham Brand of Auranofin, Yamanouchi Brand of Auranofin, Ridaura
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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