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Neuromuscular disorders associated with D-penicillamine treatment for rheumatoid arthritis
Abstract:
Three cases of D-penicillamine (DPA) induced myasthenia gravis (MG) and one case of DPA-induced polymyositis (PM) are reported among four patients suffering from seropositive rheumatoid arthritis. The cumulative doses responsible for the three DPA-induced MG cases amounted respectively to 73, 117 and 467 g. The cumulative dose responsible for the DPA-induced PM case amounted to 465 g. All the patients were HLA DR1. All four cases healed completely after withdrawal of DPA. The aetiology of the cases is discussed and the literature is reviewed. These cases represent further instances of DPA-induced neuromuscular disorders.
Insights
D-penicillamine can induce myasthenia gravis and polymyositis in rheumatoid arthritis patients. Symptoms resolved after discontinuing D-penicillamine, suggesting a drug-induced neuromuscular disorder.
Area of Science:
- Neurology
- Rheumatology
- Clinical Pharmacology
Background:
- Rheumatoid arthritis (RA) is an autoimmune disease often treated with D-penicillamine (DPA).
- DPA is known to have various side effects, including potential neuromuscular complications.
Observation:
- Four patients with seropositive rheumatoid arthritis developed neuromuscular disorders while on DPA therapy.
- Three patients presented with myasthenia gravis (MG), and one with polymyositis (PM).
- All affected patients were HLA DR1 positive.
Findings:
- D-penicillamine-induced myasthenia gravis occurred at cumulative doses of 73g, 117g, and 467g.
- D-penicillamine-induced polymyositis occurred at a cumulative dose of 465g.
- All four patients experienced complete recovery after DPA withdrawal.
Implications:
- These cases highlight D-penicillamine as a potential cause of drug-induced myasthenia gravis and polymyositis.
- The HLA DR1 association warrants further investigation in DPA-induced neuromuscular disorders.
- Discontinuation of DPA is crucial for managing these adverse events.