[5-year treatment of rheumatoid polyarthritis with D-penicillamine]

A series of thirty patients with rheumatoid arthritis in whom D-penicillamine therapy was initiated more than five years ago was analyzed. Results were satisfactory in nine patients: two (6.6%) are still taking D-penicillamine and seven (23%) have experienced stabilization of their disease. In nine patients (28%) therapy was discontinued before the end of the third year because of adverse side-effects; no harmful side-effects were recorded after the third year. In ten patients (33%) D-penicillamine was discontinued because of ineffectiveness, either during the first year because of non-responsiveness (3 patients) or after the first two years because of escape phenomenon (7 patients). The authors compare their series to those previously reported in the medical literature. They believe that D-penicillamine should be given in progressive and moderate doses (averaging 600 mg per day). The mean duration of therapy with D-penicillamine was 27 months, lower than that recorded with chrysotherapy or anti-malarials; in 30% of patients, D-penicillamine was discontinued because of adverse side-effects. These findings show that, though D-penicillamine may be useful, it should be considered only after chrysotherapy.