Penicillamine in chronic arthritis of childhood

In doses of 15 to 30 mg/kg of bodyweight, penicillamine is of benefit in up to 69% of both seropositive and seronegative juvenile polyarthritis patients when used as the 1st long-acting drug; it also helps 53% of such patients when other therapies have failed. Its use should be continued for several yr for maximum effect. Once a patient is in remission, the drug should be withdrawn slowly to avoid exacerbations. Radiologic improvement lags behind clinical. The most troublesome side effect is proteinuria. Rash is uncommon, and hematologic problems are relatively few; both usually respond to dosage alterations.