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[Myasthenia induced by D-penicillamine during the treatment of rheumatoid polyarthritis]
Abstract:
Seven cases of myasthenia induced by D-penicillamine treatment of rheumatoid arthritis are presented. The 86 cases published so far are reviewed. The clinical symptoms do not differ from those of the idiopathic form. Progress is rapid and, generally, good. The duration and dosage of the treatment are not involved. The presence of acetylcholine-antireceptor antibodies confirms the autoimmune origin of the condition. Possible mechanisms by which this disorder could be induced are discussed. Investigation of HLA phenotypes suggests that the genetic basis of induced myasthenia differs from that of the idiopathic form (increased prevalence of DR1).
Insights
D-penicillamine treatment for rheumatoid arthritis can induce myasthenia gravis, an autoimmune disorder. This drug-induced myasthenia shares symptoms with the idiopathic form but has a different genetic basis.
Area of Science:
- Rheumatology
- Neurology
- Immunology
Background:
- Rheumatoid arthritis is a chronic autoimmune disease.
- D-penicillamine is a medication used to treat rheumatoid arthritis.
- Myasthenia gravis is a neuromuscular autoimmune disease.
Observation:
- Seven cases of myasthenia gravis induced by D-penicillamine treatment for rheumatoid arthritis were observed.
- A review of 86 previously published cases was conducted.
- Clinical symptoms of drug-induced myasthenia gravis were consistent with the idiopathic form.
Findings:
- Drug-induced myasthenia gravis showed rapid and generally good recovery.
- Treatment duration and dosage did not correlate with the condition.
- Acetylcholine receptor antibodies confirmed the autoimmune origin.
- Human leukocyte antigen (HLA) phenotypes suggested a distinct genetic basis compared to idiopathic myasthenia gravis, with a higher prevalence of DR1.
Implications:
- D-penicillamine can trigger an autoimmune response leading to myasthenia gravis.
- Understanding the genetic factors may aid in predicting susceptibility.
- This highlights the importance of monitoring for neurological side effects during D-penicillamine therapy.