Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Auranofin is an oral, gold-containing chemical
(salt) used for treating rheumatoid arthritis. Other gold salts available are
injectable and include aurothioglucose (Solganal) and
gold sodium thiomalate
(Myochrysine). It is not well understood exactly how gold salts work. In
patients with inflammatory arthritis, such as adult and
juvenile rheumatoid
arthritis, gold salts decrease the inflammation of the lining of the joint. They
prevent the inflammation from destroying the bone and cartilage surrounding the
joint and deformities of the joints. Because of its ability to prevent or slow
deformities of the joints, auranofin is considered a disease modifying
anti-rheumatic drug (DMARD). Gold salts also are called second-line drugs
because they often are considered when arthritis persists in spite of the use of
antiinflammatory drugs (NSAIDs and corticosteroids). The term second-line is
misleading since anti-inflammatory drugs and DMARDs have different mechanisms of
action and in general are used together for their additive effects. DMARDs may
take weeks to months to become effective. Auranofin was FDA approved in May
1985.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Capsule: 3 mg.
STORAGE: Auranofin should be store between 15 and 30 C (59 and 86 F) and
dispensed in a tight, light-resistant container
PRESCRIBED FOR: Auranofin is used in the treatment of active, progressive or
destructive forms of inflammatory arthritis, such as rheumatoid arthritis. Off
label uses include Felty's Syndrome (a rare disorder that includes rheumatoid
arthritis, a swollen spleen, and decreased white blood cell count),
psoriatic
arthritis and juvenile rheumatoid arthritis.
DOSING: The usual adult dosage of auranofin is 3 mg twice daily.
DRUG INTERACTIONS: The concurrent use of auranofin and phenytoin (Dilantin),
an antiepileptic drug, may increase phenytoin blood levels, which may lead to
phenytoin toxicity for unclear reasons. The concurrent use of penicillamine
(Cuprimine, Depen) and gold salts may result in blood cell or kidney toxicity
since both drugs are toxic to the blood cells and kidney. The auranofin should
not be used with atovaquone/proguanil (Malarone) an antimalarial drug, as the
combination may increase the risk of toxicity to blood cells.
PREGNANCY: There are no adequate studies in
pregnant women. Use of auranofin
in pregnant women is not recommended.
NURSING MOTHERS: Auranofin has been found in the
breast milk of nursing
mothers. Nursing during auranofin therapy is not recommended.
SIDE EFFECTS: The most common side effect of auranofin is loose stools or
diarrhea. Another side effect is inflamed skin; an itching sensation can be an
early warning sign of a skin reaction, such as a rash. Auranofin also can cause
a metallic taste and mouth sores, though less frequently than injectable gold
salts. Because gold salts can cause serious kidney and bone marrow problems, all
patients require monitoring with regular testing of blood and urine.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count. Treatment of Felty's syndrome is not always required; however, treatment for patients with infections is available.
Felty's syndrome is a complication of long-standing rheumatoid arthritis. Felty's
syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen (splenomegaly),
and an abnormally low white blood count. Felty's syndrome is uncommon. It affects less than 1% of patients with rheumatoid
arthritis.
What are the symptoms of Felty's syndrome?
Some patients with Felty's syndrome have more infections, such as pneumonia or skin
infections, than the average person. This increased susceptibility to infections
is attributed to the low white blood counts that are characteristic of Felty's syndrome. Ulcers in the skin over the legs can complicate
Felty's syndrome.
What causes Felty's syndrome?
The cause of Felty's syndrome is not known. Some patients with rheumatoid arthritis develop Felty's syndrome but most do not. White blood cells are prod...
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