[Mechanism of action of gold compounds]

The mechanisms of action of gold salts are still poorly understood. While Auranofin (AF) has a direct anti-inflammatory action in animal models, Myochrysin (MC) has not. Both gold compounds inhibit various enzymes. Among these, lysosomal enzymes are of particular interest. Gold is known to accumulate in the lysosomes, and gold salts modulate certain macrophage functions in the immune system. The role of organic gold salt ligands containing, like D-penicillamine, a thiol group is still unclear. Positive data characterizing responders versus nonresponders are not yet available. As in other clinically heterogeneous diseases, medical action has mainly been based on clinical empiricism which, although resting on false premises, has helped to find a comparatively efficacious treatment. In fact, the proposals for further studies to shed light on the mode of action presented here may equally be ill conceived. However, these studies would at least expand our understanding of rheumatoid arthritis and thus be beneficial in the long run.