Oral chrysotherapy in rheumatoid arthritis: auranofin

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Intramuscular gold therapy is a widely accepted form of treatment for active rheumatoid arthritis which fails to respond to salicylates or nonsteroidal anti-inflammatory agents. However, logistical concerns, uncommon but potentially serious renal and hematologic toxicity, and the relatively high long-term dropout rate mitigate against this form of therapy. Auranofin is an orally absorbed gold compound which differs significantly from intramuscular gold in terms of both pharmacokinetics and potential mechanisms of action. Clinical experience with auranofin is reviewed both at the Cleveland Clinic and worldwide. Therapeutic efficacy compares favorably with intramuscular gold and D-penicillamine, while significantly fewer patients are withdrawn from therapy due to toxicity (most commonly, diarrhea) than with intramuscular gold. Proteinuria and thrombocytopenia are considerably less common. Auranofin may prove to be valuable in the management of severe rheumatoid arthritis and offers several potential advantages over intramuscular gold therapy.