Myasthenia gravis is a disorder of impaired neuromuscular transmission resulting in weakness and abnormal fatigability on exertion, improved by anti-acetyl cholinesterase drugs. A number of drugs are known to exacerbate myasthenia gravis or interfere with neuromuscular transmission. We report a case of D-penicillamine induced myasthenia gravis who developed ptosis, diplopia and easy fatigabilit...

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-Pe...

A 68-year-old black woman who was put on D-penicillamine therapy (250-500 mg per day, total dose 15 g) for rheumatoid arthritis developed ocular myasthenia gravis. Two weeks after she discontinued D-penicillamine her signs and symptoms cleared with no other treatment. Review of previous cases and possible immunological mechanisms are discussed.

Forty-six patients with rheumatoid arthritis, 22 receiving D-penicillamine and 2j alclofenac, took part in a 6-month single-bind external observer trial to compare the efficacy and toxicity of these drugs in the treatment of severe rheumatoid arthritis. Both drugs were active and similar in their efficacy at 6 months as judged by clinical and laboratory measurements. Penicillamine was active th...

Correspondence Failure of D-penicillamine to affect peripheral joint involvement in ankylosing spondylitis or HLA B27-associated arthropathy Sir, We have treated 7 patients with peripheral joint involvement in ankylosing spondylitis or HLA B27-associated arthropathy with D-penicillamine and all failed to show improvement. D-penicillamine has been shown to help peripheral joints in rheumatoid ar...

D-penicillamine-associated bronchiolitis obliterans (BO) is a rare but well-known pulmonary complication in patients with rheumatoid arthritis or progressive systemic sclerosis. It has been assumed that in most, if not all cases, BO is a complication of the underlying disease rather than a side-effect of treatment. We report the case of a 46 year old man with scleroderma localized to his lower ...