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Proteinuria in gold-treated rheumatoid arthritis
Annals of Internal Medicine
|August 1, 1984
Summary
Auranofin treatment for rheumatoid arthritis showed a low incidence of proteinuria, with most cases being mild and resolving within 12 months. This indicates auranofin is a safer alternative to parenteral gold therapy.
Area of Science:
- Nephrology
- Rheumatology
- Clinical Pharmacology
Background:
- Rheumatoid arthritis (RA) management often involves disease-modifying antirheumatic drugs (DMARDs).
- Gold compounds, including parenteral gold and oral auranofin, have been used in RA treatment.
- Proteinuria is a potential adverse effect of gold therapy requiring monitoring.
Purpose of the Study:
- To evaluate the incidence and characteristics of proteinuria in patients with rheumatoid arthritis treated with auranofin.
- To compare the risk of proteinuria with auranofin versus parenteral gold and nonsteroidal anti-inflammatory drugs (NSAIDs).
Main Methods:
- Retrospective analysis of treatment records from 1800 RA patients in US clinical trials of auranofin.
- Examination of 24-hour urine protein levels in auranofin-treated patients (n=1283).
- Comparison of proteinuria incidence rates with historical data for parenteral gold and NSAID therapy.
Main Results:
- 3% (41/1283) of auranofin-treated patients developed abnormal proteinuria.
- Most proteinuria was mild to moderate and did not persist beyond 12 months; permanent renal impairment did not occur.
- Auranofin-associated proteinuria risk was significantly lower than parenteral gold (p<0.05) and similar to NSAIDs (p=0.92).
- Membranous glomerulonephritis was observed in 4 patients, suggesting an immunopathologic basis.
Conclusions:
- Auranofin therapy is associated with a low incidence of proteinuria in rheumatoid arthritis patients.
- The proteinuria observed is generally mild, transient, and does not lead to permanent renal impairment.
- Auranofin demonstrates a more favorable renal safety profile compared to parenteral gold, supporting its use as a better-tolerated alternative.
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