title: Penicillamine in rheumatoid arthritis. A problem of toxicity.
abstract: 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.
authors.affiliation: Department of Rheumatology, Leicester Royal Infirmary, England.
authors.forename: H G
authors.initials: HG
authors.lastname: Taylor
authors.forename: A
authors.initials: A
authors.lastname: Samanta
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000378:metabolism; D004311:Double-Blind Method; D006801:Humans; D010396:Penicillamine / Q000009:adverse effects* / Q000493:pharmacokinetics
chemical_list: D010396:Penicillamine