Gold neurotoxicity

Steven Herskovitz MD (Dr. Herskovitz of the Montefiore Medical Center has no relevant financial relationships to disclose.)
Louis H Weimer MD, editor. (

Dr. Weimer of Columbia University has received consulting fees from Roche.

Originally released November 6, 2001; last updated December 26, 2018; expires December 26, 2021

Historical note and terminology

Gold salt therapy (chrysotherapy) has been used in the treatment of rheumatoid arthritis for many years. Its use has declined in favor of methotrexate, chloroquine, and sulfasalazine (Aletaha and Smolen 2002). It shows efficacy as a second-line treatment in refractory pemphigus vulgaris (Iranzo et al 2007). In its elemental form, it has been used for centuries as an antipruritic to relieve the itching palm (Jackson Roberts and Morrow 2001). In the early part of the last century, Robert Koch used gold for the treatment of tuberculosis on the assumption that mycobacteria were the cause of rheumatoid arthritis. The most common gold preparations are aurothioglucose and sodium aurothiomalate; they contain 50% gold by weight, are water soluble, and are administered intramuscularly. Auranofin is the only available gold compound for oral use. Chrysotherapy is reported to decrease synovial inflammation and retard cartilage and bone destruction. Its mechanism of action may be based on effects on tumor necrosis factor-alpha (Mangalam et al 2001). Neurotoxicity is uncommon, but includes encephalopathy, cranial neuropathy, myokymia, and peripheral neuropathy, including occasionally a Guillain-Barré-like clinical picture.

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