[Two-phase course of IgM and rheumatoid factors during D-penicillamine therapy]

16 patients with definite and classical rheumatoid arthritis (A.R.A. criteria) were under regular control for 210 days. 11 of them were treated with D-penicillamine and 5 with gold. They were compared to a group of 34 healthy people. In addition to clinical observations the following investigations were carried out at intervals of 20 to 30 days: Latex-fixation test and Waaler-Rose, IgM, IgA, IgG, C3, C4, C3-proactivation, ESR, coeruloplasmin, iron, complete blood picture, gamma-GT, SGOT, SGPT, alk. phosphatase, creatinine, urea and full urinalysis. Furthermore antinuclear factors (ANF) and C-3 activating ANF were determined by indirect immunofluorescence. The following observations were made: 1. The serum level of immuno-globulins changed in a two-phase fashion during D-penicillamine treatment. Initially IgM decreased significantly until the 60th to 80th day. During the 80th to 210th day it tended to increase. Rheumatoid factors changed in a similar way. 2. There was a significant correlation between the IgM serum level and the average titer of the Latex-fixation and Waaler-Rose tests. 3. The other parameters did not change significantly. 4. In one case the ANF became positive and showed a tendency to increase in titre. With higher titres complement activation was demonstrated. The treatment was discontinued. Thereafter the ANF titres and complement binding decreased gradually.