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Logo of procrsmedFormerly medchtJournal of the Royal Society of MedicineProceedings of the Royal Society of Medicine
Proc R Soc Med. 1977; 70(Suppl 3): 118–122.
PMCID: PMC1543605

Penicillamine treatment of rheumatoid arthritis: relationship of proteinuria and autoantibodies to immune status.


Thirty-seven patients were studied before and during treatment with respect to immune status, clinical response and development of adverse effects and autoantibodies. The baseline immune status was not predictive in terms of the above features, apart from the fact that the group of 7 patients developing proteinuria had a tendency to low or subnormal IgG levels. The most marked clinical improvement was recorded in the group who had augmented skin test responses sometime during the treatment period. These patients also had the largest falls in the IgG, IgA and rheumatoid factor. Antinuclear antibody persisted or increased in titre in 38% of patients, but was not associated with poor prognosis or liability to side-effects. Autoantibodies to striational or smooth muscle occurred in 20% of patients, and there was a much higher incidence of proteinuria in this group. We have previously suggested that penicillamine may act by depressing humoral function, leading to augmentation of cell-mediated immunity. Although the present findings suggest that penicillamine does cause humoral depression in some cases, it is not clear how the drug induces the side-effects described.

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Selected References

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  • Bluestone R, Goldberg LS. Effect of D-penicillamine on serum immunoglobulins and rheumatoid factor. Ann Rheum Dis. 1973 Jan;32(1):50–52. [PMC free article] [PubMed]
  • Bucknall RC, Dixon A St J, Glick EN, Woodland J, Zutshi DW. Myasthenia gravis associated with penicillamine treatment for rheumatoid arthritis. Br Med J. 1975 Mar 15;1(5958):600–602. [PMC free article] [PubMed]
  • Huskisson EC, Scott J, Balme HW, Dieppe PA, Trapnell J, Willoughby DA. Immunostimulant therapy with levamisole for rheumatoid arthritis. Lancet. 1976 Feb 21;1(7956):393–395. [PubMed]
  • Mohammed I, Barraclough D, Holborow EJ, Ansell BM. Effect of penicillamine therapy on circulating immune complexes in rheumatoid arthritis. Ann Rheum Dis. 1975 Oct;35(5):458–462. [PMC free article] [PubMed]
  • Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed]
  • Sternlieb I, Bennett B, Scheinberg IH. D-penicillamine induced Goodpasture's syndrome in Wilson's disease. Ann Intern Med. 1975 May;82(5):673–676. [PubMed]

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