What are the other Names for this Condition? (Also known as/Synonyms)

• Enlarged Lymph Nodes due to Gold Therapy
• Gold Therapy causing Enlarged Lymph Nodes
• Gold-Associated Lymphadenopathy

What is Gold Lymphadenopathy? (Definition/Background Information)

• Gold Lymphadenopathy is a condition forming enlarged and painful lymph nodes due to gold therapy. It is also known as Enlarged Lymph Nodes Associated with Gold Therapy
• In this condition, there is benign enlargement of lymph nodes in individuals, who have typically received intramuscular injections of gold, for conditions such as rheumatoid arthritis (RA) or juvenile rheumatoid arthritis (JRA)
• Generally, such individuals receive the injections for a long period of time (usually many years). These gold injections not only cause enlargement of the lymph nodes, but other parts of the body (such as the kidney or liver) may also be affected due to gold toxicity
• Stopping or discontinuing the use of such medications may help better the condition or decrease progression of Gold-Associated Lymphadenopathy. Moreover, the underlying RA or JRA may require to be treated
• The prognosis of Gold Lymphadenopathy is generally excellent with appropriate treatment and stoppage of the causative gold therapy

Who gets Gold Lymphadenopathy? (Age and Sex Distribution)

• Gold Lymphadenopathy is a rare condition that can affect individuals of any age including children and adults
• There is no specific preference for any gender (both males and females are affected)
• All racial and ethnic groups are affected and no predilection is observed

What are the Risk Factors for Gold Lymphadenopathy? (Predisposing Factors)

• Individuals with rheumatoid arthritis or juvenile rheumatoid arthritis who receive long-term intramuscular injections containing gold, as part of therapy, are at risk for Gold Lymphadenopathy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Gold Lymphadenopathy? (Etiology)

Gold Lymphadenopathy is caused by the administration of gold-based therapy as part of treatment for rheumatoid arthritis or juvenile rheumatoid arthritis, usually for several years.

• Gold is generally administered (in oral tablet form or as injections) to reduce joint inflammation and pain caused by RA
• When gold is injected to the muscles, they travel to different parts of the body causing toxicity, since gold is a foreign body
• The presence of ‘foreign’ gold particles in the lymph node causes a foreign body reaction

What are the Signs and Symptoms of Gold Lymphadenopathy?

The signs and symptoms associated with Gold-Associated Lymphadenopathy include:

• The presence of enlarged lymph nodes
• Signs and symptoms of underlying rheumatoid arthritis or juvenile rheumatoid arthritis
• Signs and symptoms of underlying gold toxicity that may include:
  • Inflammation of skin, or dermatitis
  • Damage to the kidneys, or nephritis
  • Damage to the platelet function causing thrombocytopenia purpura
  • Inflammation of blood vessels, known as vasculitis
• The most commonly affected lymph nodes include:
  • The axillary lymph nodes (in the armpits), if injection is in the shoulder
  • If the injection is to the buttocks, then the inguinal lymph nodes are affected the most

How is Gold Lymphadenopathy Diagnosed?

The diagnosis of the Gold Lymphadenopathy may involve:

• A complete physical examination and an assessment of the individual’s medical history including history and treatment of rheumatoid arthritis
• Computed tomography (CT) and magnetic resonance imaging (MRI) scans may show enlarged lymph nodes all over the body
• Tissue biopsy of the affected region: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Gold Lymphadenopathy?

The complications associated with Gold Lymphadenopathy can include:

• Severe gold toxicity resulting in many vital organs being affected (including the kidney, blood)
• Gold Therapy causing Lymphadenopathy can destroy functioning of the lymph nodes
• Extensive necrosis of the liver
• The enlarged lymph nodes may cause a concern for a diagnosis such as a lymphoma. There could be significant emotional distress, until diagnosis of a lymphoma is ruled out

How is Gold Lymphadenopathy Treated?

• Discontinuing the gold therapy (or intramuscular injections) responsible for the side effects may result in improvement of Gold Lymphadenopathy, or stop its progression
• Other treatment measures for the condition include symptomatic treatment and consideration of alternative therapy for rheumatoid arthritis

How can Gold Lymphadenopathy be Prevented?

• Currently, there are no specific methods or guidelines to prevent Gold Lymphadenopathy
• The gold-based therapy injections that caused the condition may be discontinued or alternative medications used

What is the Prognosis of Gold Lymphadenopathy? (Outcomes/Resolutions)

• The prognosis of Gold Lymphadenopathy is generally excellent on discontinuation of the offending gold therapy, followed by adequate treatment
• However, the prognosis is also associated with the severity of the underlying rheumatoid arthritis, juvenile rheumatoid arthritis, and/or gold toxicity (if any)
• Regular follow up visits with the healthcare providers are important

Additional and Relevant Useful Information for Gold Lymphadenopathy:

Research studies have generally shown that gold toxicity does not affect the growth and development of a baby in the womb.