The gold salts, gold sodium thiomalate (Aurolate), auro-thioglucose (Solganal), and auranofin (Ridaura) have been known to be effective in the treatment of RA for more than 60 years.225 Recent findings have suggested that, auranofin, an orally active gold salt, inhibits Nuclear factor kB (NF-kB) activation TLR4-mediated activation of the signaling pathway that leads to the blocking of the formation of inflammatory gene product such as cytokines and COX-2.238 Because zinc is a necessary component of NF-kB, a transcription factor that is critical for its DNA binding, Yang et al.239 suggested that auranofin works by oxidizing the zinc containing thiolate anions of NF-kB into a disulfide, thus abolishing the DNA binding requirement for gene expression. However, few patients take gold salt therapy for longer than 5 years because of their toxicities including mu-cocutaneous reactions, proteinuria, and cytopenias.222
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