Treatment of rheumatoid arthritis with penicillamine

Low‐Dose D‐Penicillamine Therapy in Rheumatoid Arthritis

“…Thrombocytopenia is a well described complication of D-penicillamine therapy, but occurred only with the highest dose of D-penicillamine in our study. Thrombocytopenia did not occur before 4 months of therapy, which was consistent with other reports (29,30), although Golding (31) has reported it as early as 4 weeks and Hill (32) found it occurring between 10-20 weeks of therapy. Neutropenia, conversely, tended to occur early and with both doses of Dpenicillamine, even occurring in the 500 mg/day group before maximum doses of D-penicillamine had been taken.…”

Controlled trial of hydroxychloroquine and d‐penicillamine singly and in combination in the treatment of rheumatoid arthritis

“…Toxicity data in the D-penicillamine group also agreed generally with what others have found, i.e., side effects arc common and must be watched for diligently, even over the long term (15)(16)(17). A total of 43% of our patients who continued with D-penicillamine therapy developed side effects, and 20% had to discontinue the use of the drug because of them.…”

Resumption of treatment with penicillamine after proteinuria.

“…All 5 patients have passed this high risk time without recurrence of proteinuria. Proteinuria, though rare after 12 months of treatment (Hill, 1977), may occur at wide ranges of dose and length of treatment (Davison et al, 1977). Urinary FDP excretion correlates with intraglomerular fibrin deposition (Davison et al, 1973) and this relates to the severity of the glomerular inflammation and may be a more sensitive indicator of glomerular disease.…”

“…In a personal series (Hill, 1977) 16 of 69 patients (23%) treated with a daily maintenance dose of 750 mg developed proteinuria exceeding 2 g/24 hours during the first 12 months of treatment and penicillamine was consequently withdrawn. In most of these 16 patients the disease subsequently became only slightly more active, but in a few deterioration was so severe that the patients and their families pressed strongly for resumption of treatment.…”