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Fatal polymyositis in D-penicillamine-treated rheumatoid arthritis

D R Doyle, T L McCurley, J S Sergent

    Annals of Internal Medicine
    |March 1, 1983
    PubMed

    Insights

    D-penicillamine can cause polymyositis and dermatomyositis, serious inflammatory muscle diseases. Patients treated with D-penicillamine require close monitoring for these adverse effects, as early detection improves outcomes.

    Area of Science:

    • Rheumatology
    • Neurology
    • Dermatology

    Background:

    • D-penicillamine is a chelating agent used in treating rheumatoid arthritis and Wilson's disease.
    • Drug-induced myopathies are a recognized but infrequent complication of certain medications.

    Observation:

    • A review of thirteen cases and a description of a fourteenth case of polymyositis or dermatomyositis developing during D-penicillamine therapy.
    • Common symptoms included proximal muscle weakness (13 patients) and dysphagia (6 patients).
    • Four patients presented with dermatomyositis, a condition involving skin rash.

    Findings:

    • Twelve of fourteen patients recovered after discontinuation of D-penicillamine.
    • Two patients experienced fatal cardiac involvement.
    • The study highlights a significant association between D-penicillamine use and the development of inflammatory myopathies.

    Implications:

    • D-penicillamine should be administered with caution in patients with rheumatoid arthritis.
    • Close monitoring for signs of polymyositis or dermatomyositis is crucial during D-penicillamine treatment.
    • Awareness of these potential side effects can lead to timely intervention and improved patient prognosis.

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