[Acetylcholine receptor antibody in D-penicillamine therapy]

Since 1978 a 63-year-old woman with rheumatoid arthritis received D-penicillamine (D-PA) in a daily dose of 250-500 mg (mean 300 mg/d). In 1982 the patient complained of diplopia for several days, the ophthalmological and neurological examinations three days later were normal. In July 1983 she developed a myasthenic syndrome, D-PA was stopped and treatment with mestinon was started. At this time anti-acetylcholine-receptor-antibodies (anti-AChR) were detectable in the patient's serum. The examination of sera stored at -80 degrees C since 1978 revealed anti-AChR existing since 1981 -1 1/2 years, however, before the temporary diplopia. Therefore in 13 other patients receiving D-PA for more than one year anti-AChR were examined. In two of these patients anti-AChR were found. The electroneurological tests were (still?) normal. The question arises whether anti-AChR should be measured routinely in patients with D-PA.