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Penicillamine in Rheumatoid Arthritis

A Problem of Toxicity

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Summary

Penicillamine has proved an effective second line agent in rheumatoid arthritis. Its use, however, is limited by its toxicity. Long term studies show that only between 30 and 40% of patients started on penicillamine are still taking the drug at 2 years. Toxicity is the chief reason for stopping treatment, the commonest adverse effects requiring cessation of therapy being proteinuria (10 to 13%), skin rashes (5 to 9%), gastrointestinal events (5%) and thrombocytopenia or leucopenia (2 to 5%). A number of autoimmune syndromes may rarely be induced by penicillamine. HLA-B8, Dr3 positive individuals and poor sulfoxidisers are at increased risk of developing toxicity. Meticulous supervision of penicillamine therapy is required to minimise toxicity.

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  1. Department of Rheumatology, Leicester Royal Infirmary, Infirmary Square, Leicester, LEI 5WW, England

    H. G. Taylor &  A. Samanta (Consultant Pysician)

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  1. H. G. Taylor
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  2. A. Samanta
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Taylor, H.G., Samanta, A. Penicillamine in Rheumatoid Arthritis. Drug-Safety 7, 46–53 (1992). https://doi.org/10.2165/00002018-199207010-00006

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