title: Successful treatment of methotrexate induced nodulosis with D-penicillamine.
abstract: Accelerated nodulosis is a recognized complication of methotrexate (MTX) therapy in rheumatoid arthritis (RA). We describe 3 patients with accelerated nodulosis treated with D-penicillamine (D-Pen) while continuing MTX. The combination of D-Pen with MTX therapy resulted in regression of subcutaneous nodules in all patients, disappearance of pulmonary nodules in one patient, and resolution of vasculitic lesions in 2 patients. Clinical response was observed within the first few weeks of therapy and usually required moderate doses (500 mg/day). Our observations suggest that addition of D-Pen to MTX therapy can be an alternative therapeutic option for accelerated nodulosis in patients with RA.
authors.affiliation: Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dash
authors.forename: J R
authors.initials: JR
authors.lastname: Seibold
authors.forename: M L
authors.initials: ML
authors.lastname: Tiku
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D010396:Penicillamine / Q000627:therapeutic use*; D012074:Remission Induction; D012218:Rheumatoid Nodule / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents; D010396:Penicillamine; D008727:Methotrexate