What are the other Names for this Condition? (Also known as/Synonyms)

Gold Poisoning

Heavy Metal Poisoning due to Gold

Toxicity due to Gold

What is Gold Toxicity? (Definition/Background Information)

Gold Toxicity is the toxic effect of gold that occurs when gold is administered to the body. It is usually given for rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), or psoriatic arthritis

Gold is generally administered to reduce joint pain and joint swelling. In many, gold treatment helps in decreasing joint deformity and joint disability. Although, in about 50% of the individuals, the injections may not be an effective treatment tool

Individuals with the genotype HLA-DR3 have a higher risk for gold therapy-induced Gold Toxicity. In such individuals, kidney toxicity and platelet dysfunction may occur

Gold Toxicity long-term effects may include liver inflammation, blue-grey skin color, and mouth ulcers. There can also be bone marrow suppression resulting in frequent infections

Stopping or discontinuing the use of gold therapy is the first line of treatment for Gold Toxicity. The treatment for arthritis using gold may be resumed, if the side effects improve and go away

The prognosis of Gold Toxicity is generally good with appropriate early diagnosis and treatment including stoppage of the causative gold therapy

Who gets Gold Toxicity? (Age and Sex Distribution)

Gold Toxicity can affect individuals of any age including children and adults. It is a rare condition

There is no specific preference for any gender (both males and females are affected)

All racial and ethnic groups are affected and no predilection is observed

What are the Risk Factors for Gold Toxicity? (Predisposing Factors)

The risk factors for Gold Toxicity may include:

Individuals with rheumatoid arthritis, juvenile rheumatoid arthritis, or psoriatic arthritis who are administered (long-term) gold therapy

Presence of the genotype HLA-DR3 is a risk factor

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Gold Toxicity? (Etiology)

Gold Toxicity is caused by the administration of gold-based therapy as part of treatment for rheumatoid arthritis, juvenile rheumatoid arthritis, or psoriatic arthritis, usually for several years.

Gold therapy is usually given as injections, but it may be orally administered (in capsule form) too. It helps reduce joint inflammation and pain caused by the arthritis

When gold is injected to the muscles, they travel to different parts of the body causing toxicity, since gold is a foreign body

Gold therapy may be given early in the course of the condition, when other treatment measures, such as steroid and OTC pain medications, do not work

What are the Signs and Symptoms of Gold Toxicity?

The side effects of gold therapy occur in about 1 in 3 individuals. In some individuals, immediate side effects (called nitritoid reaction) are noted after gold therapy. The signs and symptoms of Gold Toxicity may include:

Inflammation of skin, or dermatitis

Damage to the kidneys, or nephritis

Damage to the platelet function causing thrombocytopenia Purpura

Inflammation of blood vessels, known as vasculitis

Enlarged lymph nodes, or lymphadenopathy

Pruritus or itching

Proteinuria or presence of protein in urine

The hair, nails, and lips are usually not affected

In majority of the cases, the signs and symptoms are mild and go away on its own. In some cases, it can be severe and additionally result in the following:

Low blood pressure (BP)

Nausea

Loss of consciousness

The signs and symptoms associated with long-term Gold Toxicity (which are generally long-lasting) may include:

Bluish-grey discoloration of skin on the sun-exposed areas. This is known as chrysiasis and is an irreversible condition

Increased pigmentation can also occur in the lens/cornea of the eye; a condition called ocular chrysiasis

Mouth sores

Inflammation of liver, or hepatitis

Bone marrow suppression leading to anemia and frequent infections

Moreover, there may be signs and symptoms of the underlying rheumatoid arthritis, juvenile rheumatoid arthritis, or psoriatic arthritis.

How is Gold Toxicity Diagnosed?

The diagnosis of the Gold Toxicity may involve:

A complete physical examination and an assessment of the individual’s medical history including history and treatment of rheumatoid arthritis or psoriatic arthritis

Computed tomography (CT) and magnetic resonance imaging (MRI) scans

Tissue biopsy of the affected region: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Gold Toxicity?

The complications associated with Gold Toxicity can include:

Diarrhea may result from taking oral drug (gold) therapy

Neurological complications such as severe neuropathies

Severe gold toxicity resulting in many vital organs being affected, including the kidney, liver, and blood

Individuals with HLA-DR3 have a greater chance of getting kidney toxicity (nephropathy) and platelet dysfunction causing immune thrombocytopenia

Gold Poisoning can destroy the function of the lymph nodes

Extensive necrosis of the liver

Rarely, it can cause heart attacks and strokes

How is Gold Toxicity Treated?

Discontinuing the gold therapy (or intramuscular injections) responsible for the side effects may result in improvement of Gold Toxicity signs and symptoms and also help stop its progression

Other treatment measures for the condition include symptomatic treatment and consideration of alternative therapy for rheumatoid arthritis or psoriatic arthritis

In many cases, gold therapy is stopped for a period of time for the signs and symptoms of Gold Toxicity to get better, and the treatment is then resumed. If the side effects return, then the individual is not a candidate for gold therapy and it should be avoided.

How can Gold Toxicity be Prevented?

Currently, there are no specific methods or guidelines to prevent Gold Toxicity

The gold-based therapy injections that caused the condition may be discontinued or alternative medications used

What is the Prognosis of Gold Toxicity? (Outcomes/Resolutions)

The prognosis of Gold Toxicity is generally good on discontinuation of the offending gold therapy, followed by adequate treatment

However, the prognosis is also associated with the severity of Gold Toxicity and underlying rheumatoid arthritis or psoriatic arthritis

Regular follow up visits with the healthcare providers are important: Early diagnosis and treatment of the condition may prevent worsening or acute side effects due to Gold Poisoning

Additional and Relevant Useful Information for Gold Toxicity: