[Autoimmune phenomena in D-penicillamine therapy]

Area of Science:

• Immunodermatology
• Rheumatology
• Pharmacology

Context:

• Rheumatoid arthritis (RA) management often involves disease-modifying antirheumatic drugs (DMARDs).
• D-penicillamine is a chelating agent and DMARD used in treating RA and other autoimmune conditions.
• Cutaneous adverse drug reactions (ADRs) are a known complication of D-penicillamine therapy.

Purpose:

• To investigate the occurrence of immunoglobuline deposits in the skin during D-penicillamine treatment.
• To correlate specific skin reactions with immunological markers such as antinuclear antibodies (ANA).
• To prospectively monitor immunological changes in patients receiving D-penicillamine.

Summary:

• Two rheumatoid arthritis patients on D-penicillamine developed skin manifestations: drug-induced exanthema and pemphigus erythematosus.
• Immunoglobulin deposits were detected in the skin of affected patients.
• One patient showed elevated ANA titers and increased antibody binding to denatured DNA preceding the skin reaction.
• A prospective study of ten additional patients revealed no significant changes in ANA or DNA-binding capacity without skin lesions.

Impact:

• Highlights potential immunodermatological side effects of D-penicillamine.
• Suggests monitoring ANA levels may be relevant in patients developing skin reactions.
• Informs clinicians about potential immunological monitoring strategies for D-penicillamine-induced cutaneous ADRs.