Gold: an old drug still working in refractory pemphigus

BACKGROUND: The mainstay of treatment for pemphigus is systemic corticosteroids. Different adjuvants have been used to reduce side-effects of long-term corticotherapy. Gold is an anti-inflammatory drug used in autoimmune diseases, whose use has waned with the advent of new immunosuppressive agents. OBJECTIVE: To study the outcome of the use of intramuscular gold treatment of pemphigus vulgaris refractory to previous therapies. METHODS: Thirteen patients with pemphigus vulgaris who had failed to respond to several prior therapies were treated with aurothiomalate, as a steroid-sparing agent. Patients were monitored to assess disease activity and gold toxicity. RESULTS: Seven patients achieved complete remission. Four patients were able to taper prednisone doses, although pemphigus flared when prednisone was discontinued or reduced. Toxicity was observed in the other two patients. CONCLUSIONS: In 53.4% of the patients, the use of chrysotherapy resulted in the complete clearing of the disease, discontinuation of all systemic therapies and induced a long-term clinical remission. Prednisone doses were able to be reduced in the remaining 46.6%. Any side-effects were reversible with drug discontinuation. Gold therapy showed efficacy as a secondary line treatment in refractory pemphigus vulgaris.     

GOLD: human exposure and update on toxic risks

Abstract

Gold is ubiquitous in the human environment and most people are in contact with it through wearing jewelry, dental devices, implants or therapies for rheumatoid arthritis. Gold is not a nutrient but people are exposed to it as a food colorant and in food chains. The present review discusses the hazards faced in personal and domestic use of gold and the far greater risks presented through occupational exposure to the metal in mining and processing gold ores. In the last situation, regular manual contact or inhalation of toxic or carcinogenic materials like mercury or arsenic, respectively, presents far greater hazard and greatly complicates the evaluation of gold toxicity. The uses and risks presented by new technology and use of nanoparticulate gold in anti-cancer therapies and diagnostic medicine forms a major consideration in gold toxicity, where tissue uptake and distribution are determined largely by particle size and surface characteristics. Many human problems arise through the ability of metallic gold to induce allergic contact hypersensitivity. While gold in jewelry can evoke allergic reactions, other metals such as nickel, chromium and copper present in white gold or alloys exhibit more serious clinical problems. It is concluded that toxic risks associated with gold are low in relation to the vast range of potential routes of exposure to the metal in everyday life.     

Distribution of gold in human platelets after in-vitro interaction and during chrysotherapy with gold sodium thiomalate

We have studied the distribution of gold in platelets from patients with rheumatoid arthritis (RA) undergoing chrysotherapy and, in vitro, in platelets reacted with gold sodium thiomalate. In vitro, electron dense fibrillar particles within membrane bound structures were detected in preparations containing 50 μg/ml or more of Au. Energy dispersive spectroscopy confirmed the presence of gold and sulphur in these particles. Gold was detected in platelets from RA patients by neutron activation analysis, but not by electron microscopy.     

Ocular chrysiasis

Thirty-four patients who had received over 1 gram of gold compounds for rheumatoid arthritis were examined for ocular chrysiasis. Ninety-seven percent of the patients receiving continuous chrysotherapy at the time of their ocular examination exhibited corneal chrysiasis. With few exceptions, corneal gold deposits were limited to the posterior one-half of the corneal thickness. Deposits tended to concentrate inferiorly and to spare the superior and peripheral cornea. Duration of chrysotherapy correlated positively with the clinically graded density of deposits. In this series, 55% (16/29) of these patients receiving gold therapy for three years or more had lenticular chrysiasis, although this has previously been considered rare. Our data suggest that gold is deposited in the cornea and lens from the anterior chamber aqueous fluid.     

Alveolitis during Chrysotherapy for Rheumatoid Arthritis

ABSTRACT. A patient who developed dry cough and increasing breathlessness during chrysotherapy for seropositive rheumatoid arthritis is presented. Chest radiograms were repeatedly normal, but there was a moderate decrease in pulmonary diffusing capacity. Transbron-chial lung biopsy showed alveolitis. No cellular immunity to gold salts could be demonstrated in vitro. Pulmonary function improved after withdrawal of gold, indicating that chrysotherapy rather than systemic rheumatoid disease was the cause of the alveolitis.