Penicillamine in rheumatic diseases: a prospective study of tolerance and efficacy

Tolerance to D-penicillamine was studied prospectively over an 8-yr period in 318 patients with inflammatory rheumatic disorders. Adverse reactions, observed in 76% of patients, required permanent withdrawals in only 47% of the 318. Withdrawals could be reduced by lowering dosage and making increments extremely slowly. In 207 rheumatoid arthritis patients who had received gold thiomalate, adverse reactions to D-penicillamine were fewer than with the gold and, less often, caused permanent withdrawals. Of 164 nonresponders to gold thiomalate, 53% responded to D-penicillamine. Only 10% of nonresponders to D-penicillamine responded to gold thiomalate.