The gold preparations available in the United States include two preparations administered via intramuscular injection: gold sodium thiomalate (GSTM, Myochrysine, Aurolate) and aurothioglucose (gold sodium thioglu-cose, GSTG, Solganal), and an oral preparation, aura-
nofin (Ridaura). Although called gold salts, these compounds contain monovalent gold bound to sulfur, a bond that is at least partly covalent. For this reason, these complexes are termed gold preparations or gold compounds in this chapter.
The mechanism by which gold compounds produce their antiarthritic effects is not known. Since gold therapy can suppress the increased phagocytic activity that occurs in rheumatoid arthritis, the antirheumatic activity of gold preparations may involve the inhibition of either antigen processing by macrophages or lysosomal enzyme release in the joint. Gold preparations also directly inhibit certain lysosomal enzymes found in poly-morphonuclear leukocytes and macrophages.
Generally, 2 months of multiple dosing of gold compounds is required to reach steady-state levels. Auranofin therapy produces lower steady-state blood gold concentrations than does treatment with par-enteral gold compounds, but it also produces a lower incidence of adverse effects.
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