Gold Toxicity

Overview

Gold toxicity refers to the harmful effects caused by gold compounds in the body. The main source is medical: for much of the twentieth century, injectable and oral gold salts were used to treat rheumatoid arthritis. These treatments are now used far less often because newer, safer medicines are available, but reactions can still occur in people who received them or who are exposed to gold in other ways.

Gold can accumulate in the skin, kidneys, blood-forming tissue, and mucous membranes. Reactions range from mild rashes and mouth irritation to more serious effects on the kidneys and blood counts. A distinctive complication called chrysiasis is a permanent blue-gray discoloration of sun-exposed skin from gold deposits. Recognizing toxicity early and stopping the gold is the cornerstone of management.

Symptoms

Gold-related reactions can affect several parts of the body and vary widely in severity.

• Itchy skin rashes, sometimes resembling other skin conditions
• A metallic taste, mouth ulcers, or sore, inflamed gums
• Blue-gray discoloration of sun-exposed skin (chrysiasis), which is usually permanent
• Easy bruising or bleeding and signs of low blood counts
• Frothy or reduced urine, swelling, and other signs of kidney involvement
• Less commonly, cough or breathing problems from lung inflammation

Some effects, such as falling blood counts or kidney problems, may have few outward symptoms early on, which is why people on gold therapy were monitored with regular blood and urine tests.

Causes

The main cause of gold toxicity is treatment with gold-based medicines, which deposit gold throughout body tissues over time. Contributing factors include:

• Gold salt therapy: Injectable or oral gold once used for rheumatoid arthritis.
• Cumulative dose: Risk of certain effects, including skin discoloration, rises with the total amount received.
• Sun exposure: Light can drive the development of skin discoloration where gold has deposited.
• Other exposures: Rarely, occupational or environmental contact with gold compounds.

An individual's sensitivity varies, so some people develop reactions at lower exposures than others.

Risk Factors

• Past or current treatment with gold salts for rheumatoid arthritis
• A high cumulative dose of gold over time
• Significant sun exposure during or after gold therapy
• A personal tendency toward drug allergies or skin reactions
• Pre-existing kidney problems, which can be worsened by gold

Diagnosis

Diagnosis rests on a history of gold exposure combined with examination and tests that look for organ involvement:

• Medication history: Identifying past or current gold therapy.
• Blood tests: Checking blood counts for drops in white cells, red cells, or platelets.
• Urine tests: Looking for protein that signals kidney involvement.
• Skin examination or biopsy: To confirm gold-related skin discoloration when it appears.

Because rheumatoid arthritis itself and other medicines can cause overlapping problems, careful evaluation is needed to attribute symptoms to gold.

Treatment

The most important step is to stop the gold medication, which should be done with the prescribing doctor so the underlying arthritis can be managed with a safer treatment. Other steps address the specific reaction.

• Stopping gold: Discontinuing therapy and switching to an alternative for the arthritis.
• Treating skin and mouth reactions: Topical corticosteroids and soothing mouth care for rashes and ulcers.
• Managing blood and kidney effects: Close monitoring and, in severe cases, treatments to support recovery of blood counts or kidney function.
• Chelation: In selected serious cases, medicines that bind gold may be used under specialist care.
• Sun protection: Limiting light exposure to reduce or prevent skin discoloration.

Many reactions improve after gold is stopped, but skin discoloration from chrysiasis is usually permanent.

Prevention

• Use gold therapy only when prescribed and attend all recommended monitoring visits
• Have regular blood and urine tests during treatment to catch problems early
• Report new rashes, mouth sores, unusual bruising, or changes in urine promptly
• Protect skin from the sun while on or after gold therapy
• Keep a record of any past gold treatment to share with future doctors

When to See a Doctor

See a doctor if you are taking or have taken gold-based medicine and develop a rash, mouth sores, unusual bruising or bleeding, or changes in your urine. Seek urgent care for signs of a serious reaction, such as widespread blistering or peeling skin, fever with a rash, severe bleeding, or breathing difficulty, as these need prompt evaluation.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Rheumatoid arthritis medicines.
2. DermNet. Chrysiasis.
3. American College of Rheumatology. Rheumatoid arthritis treatment.
4. National Library of Medicine. Gold salts and adverse effects.