Synthetic D(-)penicillamine in rheumatoid arthritis. Double-blind controlled study of a high and low dosage regimen.

Guidelines for the management of rheumatoid arthritis: 2002 Update

“…AZA, a purine analog myelosuppressant, has demonstrated benefits in controlling RA, but it is rarely used (98)(99)(100)(101)(102). D-Pen is effective (98,99,103,104), but its use is limited, in part, by an inconvenient dosing schedule (i.e., slow increases in the dosage) and rare, but potentially serious, complications, including autoimmune diseases, such as Goodpasture's syndrome and myasthenia gravis. Intramuscular gold treatment is effective (98,99,105), but injections are required every week for 22 weeks before less-frequent maintenance dosing is initiated.…”

Inhibition of Human Helper T Cell Function In Vitro by d-Penicillamine and CuSO4

“…D-Penicillamine (Pen)' has been demonstrated to be an effective agent in the treatment of rheumatoid arthritis (1)(2)(3)(4)(5). Despite extensive clinical experience with this drug, the explanation for its capacity to suppress rheumatoid inflammation remains unclear.…”

Hepatic Organelle Pathology in Primary Biliary Cirrhosis and the Response to Low-Dose D-Penicillamine Therapy

“…Thus D-penicillamine may be an effective treatment for primary biliary cirrhosis, but it has not been established that the benefit from D-penicillamine justifies the risks of treatment. In rheumatoid arthritis a low dose of D-penicillamine appears to be effective and to have fewer sideeffects (Dixon et al, 1975;Jaffe, 1975). This is possibly because at a low dose D-penicillamine is not metabolized to more toxic and more immunogenic metabolites and the situation in primary biliary cirrhosis may be similar.…”

“…However, there are indications that a low dose of n-penicillamine is effective in rheumatoid arthritis and that on a low-dose regimen side-effects are less common (Dixon, Davies, Dormandy, Hamilton, Holt, Masson, Thompson, Weber & Zutshi, 1975;Jaffe, 1975).…”