Penicillamine‐induced myasthenia gravis in progressive systemic sclerosis

Torres, Carlos F.; Griggs, Robert C.; Baum, John; Penn, Alan

doi:10.1002/art.1780230414

Cited by 33 publications

(2 citation statements)

References 32 publications

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“…It is invariably associated with antibodies to the acetylcholine receptor which fall in titre on withdrawal of the drug, and resolution usually follows (Garlepp et al 1983). The temporal relationship of myasthenia gravis to penicillamine therapy, subtle differences in antibody affinity, distinct human leucocyte antigen (HLA) associations (Garlepp et al 1983) and its occurrence in diseases other than RA (Masters et al 1977;Torres et al 1980), all suggest that penicillamine induces the disease rather than 'unmasking' it. RA patients on penicillamine but without myasthenia gravis have no impair-49 ment of neuromuscular transmission, demonstrating that the drug does not directly interfere with motor endplate function (Albers et al 1981).…”

Section: Autoimmune Syndromesmentioning

confidence: 99%

Penicillamine in Rheumatoid Arthritis

Taylor

Samanta

1992

Drug Safety

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Penicillamine has proved an effective second line agent in rheumatoid arthritis. Its use, however, is limited by its toxicity. Long term studies show that only between 30 and 40% of patients started on penicillamine are still taking the drug at 2 years. Toxicity is the chief reason for stopping treatment, the commonest adverse effects requiring cessation of therapy being proteinuria (10 to 13%), skin rashes (5 to 9%), gastrointestinal events (5%) and thrombocytopenia or leucopenia (2 to 5%). A number of autoimmune syndromes may rarely be induced by penicillamine. HLA-B8, Dr3 positive individuals and poor sulfoxidisers are at increased risk of developing toxicity. Meticulous supervision of penicillamine therapy is required to minimise toxicity.

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Section: Autoimmune Syndromesmentioning

confidence: 99%

Penicillamine in Rheumatoid Arthritis

Taylor

Samanta

1992

Drug Safety

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“…Especially in rheumatoid arthritis, D-penicillamine has been accepted as an effective second line treatment. In spite of its effectiveness, however, it causes many adverse effects, such as skin rashes [101,102], taste abnormalities [102,103], hepatic dysfunction [104][105][106], gastrointestinal toxicity [101,107], proteinuria [102,108], hematuria [109,110], thrombocytopenia [94,111], aplastic anemia [112], lupus-like syndrome [113,114], Goodpasture's-like pulmonary renal syndrome [115][116][117], vasculitis [118,119], myasthenia gravis [120][121][122][123][124], polymyositis [125,126], and dermatomyositis [127]. One or more of these adverse reactions was seen in about 60% of patients treated with Dpenicillamine [102,[128][129][130][131].…”

Section: Introductionmentioning

confidence: 99%