D-penicillamine Induced Myasthenia Gravis

Rheumatoid arthritis can be a very mutilating disease and, as a result, the likelihood of patients with rheumatoid arthritis requiring surgery and anaesthesia is increased. D-penicillamine (D-Pen) has been used in the treatment of rheumatoid arthritis and Wilson's disease since the early 1960s. Its true mode of action is unknown, but it appears to modify the immune response. Treatment with D-Pen is associated with many side effects, one of which is the induction of several conditions of which autoantibody production is a feature; for example, systemic lupus erythematosus, pemphigus, Goodpasture's syndrome, polymyositis, autoimmune thyroiditis and myasthenia gravis (Bucknall et al., 1975; Bucknall, 1977; Gordon and Burnside, 1977). A variety of auto-antibodies may be detected following the administration of D-Pen: anti-nuclear factor, anti-striational antibodies and anti-acetylcholine receptor antibodies (Masters et al., 1977; Russel and Lindstrom, 1978; Vincent, Newsom-Davis and Martin, 1978).