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Gold TherapyAka: Gold Injection, Oral Gold, Auranofin, Ridaura

Indications (Replaced by Methotrexate)
1. Rheumatoid Arthritis
2. Seropositive Rheumatoid Arthritis
Efficacy (replaced by Methotrexate)
1. Response rate
  1. Injection: 75%
  2. Oral: 50-60%
2. Slowest therapeutic response of DMARD (3-6 months)
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)
Monitoring
1. Indications to hold gold therapy
  1. Urinalysis with >2+ Proteinuria
  2. Complete Blood Count with cell line depression
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
Dose
1. Oral: 3 mg PO bid

Auranofin (C0004320)
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	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	D001310
English	Auranofin, Auranofin - chemical, AURANOFIN PREPARATION
Spanish	auranofina
Parent Concepts	Aurothioglucose (C0018033), Immunosuppressive Agents (C0021081), [MS106] GOLD COMPOUNDS, ANTIRHEUMATIC (C0003210), Gold (C0018026), Medicinal gold (C0359627), Duplicate concept (C1274013), Immunomodulators (C1527392)
Sources	CSP, LCH, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

Ridaura (C0699923)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	D001310
English	Auranofin Recordati Brand, Auranofin Yamanouchi Brand, Recordati Brand of Auranofin, Ridaura, SmithKline Beecham Brand of Auranofin, Yamanouchi Brand of Auranofin
Sources	MSH, MTH, RXNORM Derived from the NIH UMLS (Unified Medical Language System)