Auranofin, although already licensed for rheumatoid arthritis and explored in phase II oncology trials, has so far been assessed for UBA1 re-activation only in pre-clinical systems, with no registered VEXAS trial; its off-label use may occur on a compassionate basis, but broad adoption awaits formal efficacy and dosing studies (6). The gene discussed is UBA1; the disease is rheumatoid arthritis.