ConditionBlood & immune system
Gold Toxicity
Gold toxicity refers to side effects from gold compounds (gold salts), which were used for decades to treat rheumatoid arthritis before modern drugs such as methotrexate and biologics replaced them. Reactions affect up to a third of people treated and most often involve the skin and mouth: itchy rashes and mouth ulcers. More serious effects include kidney damage with protein in the urine and dangerous falls in blood cells. Long-term use can permanently turn sun-exposed skin blue-gray, a condition called chrysiasis.
Also called: Gold salt toxicity, chrysotherapy side effects, gold poisoning, chrysiasis (skin pigmentation), adverse reaction to gold salts
At a glance
- What it is
- Adverse effects of gold compounds used as disease-modifying treatment for rheumatoid arthritis.
- Drugs involved
- Injectable gold (sodium aurothiomalate, aurothioglucose) and oral auranofin.
- Most common effects
- Itchy rash, mouth ulcers, metallic taste, diarrhea (especially oral gold).
- Serious effects
- Protein in urine (nephrotic syndrome), low platelets, low white cells, aplastic anemia, lung inflammation.
- Chrysiasis
- Permanent blue-gray skin color after large cumulative doses.
- Treatment
- Stop gold; steroids for severe reactions; chelation rarely.
When to get help
Call 911 or go to the ER
- Fever, sore throat, mouth ulcers or infections with unusual bruising or bleeding while on gold (possible bone marrow failure)
- Widespread blistering or peeling rash, or swelling of the face and throat
- Severe flushing, dizziness, sweating or fainting soon after a gold injection (nitritoid reaction)
See a doctor within a day or two
- New rash, itching or mouth sores while on gold treatment: hold the next dose and contact your doctor
- Foamy urine, ankle swelling or blood in the urine
- New cough or shortness of breath
- Severe or bloody diarrhea
Book a routine appointment
- Gray or bluish skin discoloration on the face or hands after years of gold treatment
- Regular blood and urine monitoring while taking gold
What gold therapy is
Gold compounds were among the first disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis. They reduce inflammation by altering immune cell function, though the exact mechanism is not fully understood. Their use has declined sharply because newer drugs work better and are safer. Injectable gold is no longer marketed in the US, but oral auranofin may still be encountered, and many older adults were treated with gold in the past.
Side effects of gold
| Organ | Effects | How common |
|---|---|---|
| Skin | Itchy rash (often lichen planus-like or eczema-like), itchy skin, hair loss | Most common |
| Mouth | Ulcers, stomatitis, metallic taste | Common |
| Gut | Diarrhea and abdominal cramps (oral auranofin); rarely enterocolitis | Common with oral gold |
| Kidney | Protein in urine, sometimes nephrotic syndrome (membranous nephropathy); blood in urine | Uncommon |
| Blood | Eosinophilia, low platelets, low white cells, aplastic anemia | Rare but serious |
| Lungs | Interstitial pneumonitis with cough and breathlessness | Rare |
| Liver | Cholestatic liver injury | Rare |
| Eyes | Gold deposits in the cornea and lens (usually harmless) | With long-term use |
| Injection reactions | Flushing, dizziness, low blood pressure (nitritoid reaction) | Uncommon |
Chrysiasis
Chrysiasis is a permanent blue-gray or slate-colored pigmentation of the skin, especially on sun-exposed areas such as the face and hands, caused by gold deposits in the skin. It generally occurs after large cumulative doses, and sun exposure or laser treatment can trigger or worsen it. It is harmless but does not fade on its own; certain lasers have been used to lighten it.
Gold allergy outside medicine
Allergic contact dermatitis to gold jewelry, dental gold or gold in some injections is a separate issue: an itchy rash where gold touches the skin, confirmed by patch testing.
Diagnosis
Gold toxicity is diagnosed by linking new symptoms to treatment, supported by monitoring tests:
- Complete blood count to detect falling platelets or white cells.
- Urine tests for protein and blood.
- Liver function tests.
- Chest imaging if breathing symptoms appear.
- Skin biopsy occasionally, for rashes or pigmentation.
People receiving gold had blood and urine checked before each injection or regularly on oral gold.
Treatment
- Stop gold therapy. Mild skin and mouth reactions often resolve within weeks; sometimes treatment can be cautiously restarted at a lower dose.
- Topical or oral corticosteroids for significant rashes, mouth ulcers or lung inflammation.
- Kidney involvement: usually resolves slowly over months to a couple of years after stopping.
- Blood problems: stopping gold, steroids, and in severe marrow failure, specialist treatment including transfusions and growth factors.
- Chelation therapy (such as dimercaprol) has been used for severe toxicity, though evidence is limited.
- Switching to another rheumatoid arthritis treatment.
Outlook
Most side effects improve after gold is stopped, though kidney changes can take months to clear and chrysiasis is usually permanent. Aplastic anemia is the most dangerous complication and can be fatal.
Frequently asked questions
What are the side effects of gold therapy?
The most common are itchy skin rashes, mouth ulcers, a metallic taste and, with oral gold, diarrhea. Serious effects include protein in the urine, low blood counts, lung inflammation and, rarely, aplastic anemia. Regular blood and urine tests were used to detect them early.
What is chrysiasis?
Chrysiasis is permanent blue-gray discoloration of the skin caused by gold deposits after long-term gold treatment. It is most visible on sun-exposed skin such as the face and hands. It does not harm health but usually does not fade on its own.
Is gold still used to treat rheumatoid arthritis?
Rarely. Gold salts have been largely replaced by more effective and safer drugs such as methotrexate, other conventional DMARDs and biologic medicines. Injectable gold is no longer marketed in the US.
Can you be allergic to gold?
Yes. Some people develop allergic contact dermatitis from gold jewelry or dental gold, causing an itchy rash at the contact site. A patch test can confirm gold allergy. This is different from toxicity caused by gold medicines.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Rheumatology: Guideline for the treatment of rheumatoid arthritis
- MedlinePlus: Auranofin
- LiverTox (NIH): Gold preparations
- Merck Manual Professional: Disease-modifying antirheumatic drugs
- DermNet: Chrysiasis