抄録
D-Penicillamine is being used with increasing frequency in the treatment of rheumatoid arthritis. We describe here a patient with rheumatoid arthritis who developed lupus erythematosus-like syndrome after treatment with D-Penicillamine.
The patient is a 65-year-old woman who developed rheumatoid arthritis about 19 years ago. D-Penicillamine was administered from Sep., 1976, in dosage of 200 mg/day in both initial and maintenance stages. Though white blood cells and platelets began to decrease about 17 months after the initiation of treatment, the administration of D-Penicillamine was continued. Three months thereafter, blood counts still remained low. Consequently, a blood disorder due to D-Penicillamine or the concomitantly used indomethacin was suspected and the treatment was discontinued. Dosage of prednisolone was promptly increased to 30 mg/day, and then gradually reduced. White cell and platelet counts improved smoothly for the time being, but again decreased respectively to 3, 000 and 10x 104 about 4 months after the withdrawal of D-Penicillamine (when 13 mg/day prednisolone was administered). Around that time, hair loss, mouth ulcers and photo-hyper-sensitivity were present, and generalized swelling and pain of the joints became intense.
Laboratory examination disclosed a positive LE cell preparation, a positive antinuclear antibody, negative anti-nDNA, slight decrease in CH50, and erythrocyte sedimentation rate of 110 mm/h.
From the above findings, we considered the decrease in white cell and platelet counts to be the initial sign of SLE, and diagnosed the condition as lupus erythematosus-like syndrome accompanying D-Penicillamine treatment.
As dosage of prednisolone was increased to 20 mg/day and gradually reduced subsequently, symptoms (hair loss, mouth ulcers and photosensitivity) nearly disappeared 8 months after the withdrawal of D-Penicillamine and laboratory data were normalized about 12 months after that.
