title: Upper and lower airway disease in penicillamine treated patients with rheumatoid arthritis.
abstract: Four of 133 patients with rheumatoid arthritis suddenly developed progressive respiratory symptoms while receiving penicillamine therapy. None had previous disease. None of 89 patients treated with gold alone and 0 of 380 not taking gold or penicillamine developed respiratory symptoms. Two of the 4 developed simultaneous severe, unresponsive sinusitis. Lung biopsy demonstrated obliterative bronchiolitis (OB) in 2 patients, fibrosing alveolitis in one. A clinical course characteristic of OB was noted in the 4th patient. Sinus biopsy in 2 demonstrated lymphocytic and plasmacytic mucosal infiltration. The high frequency of OB in penicillamine treated patients and its absence in 469 non penicillamine treated patients suggests the possibility of a causal relationship.
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001706:Biopsy; D001991:Bronchitis / Q000139:chemically induced; D005260:Female; D006046:Gold / Q000627:therapeutic use; D006801:Humans; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010396:Penicillamine / Q000009:adverse effects* / Q000627:therapeutic use; D012140:Respiratory Tract Diseases / Q000139:chemically induced*; D012852:Sinusitis / Q000139:chemically induced
chemical_list: D006046:Gold; D010396:Penicillamine