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  • Updated 02.11.2021
  • Released 11.06.2001
  • Expires For CME 02.11.2024

Gold neurotoxicity

Introduction

Overview

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 (01). It shows efficacy as a second-line treatment in refractory pemphigus vulgaris (10). In its elemental form, it has been used for centuries as an antipruritic to relieve the itching palm (11). 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 (15). Neurotoxicity is uncommon, but includes encephalopathy, cranial neuropathy, myokymia, and peripheral neuropathy, including occasionally a Guillain-Barré-like clinical picture.

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