About Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease of unknown origin. The characteristic feature is persistent inflammatory synovitis, typically involving peripheral joints distributed symmetrically. Synovial inflammation can lead to cartilage damage, bone erosions, and ultimately compromise of joint integrity. The vast majority of patients develop RA between age 35 and 50, with three times as many women affected as men.1
Clinical manifestations and diagnostic considerations
Pain in affected joints is aggravated by movement. That is the most common manifestation of RA. Besides pain and limitation of motion, other cardinal symptoms include swelling and tenderness. The knee, forefoot, ankles, and hands are among the most commonly involved joints.
In the absence of a specific test, diagnosis is generally based on the presence of key RA features that include bilateral symmetric inflammatory polyarthritis. The presence of rheumatoid factor is not RA-specific. It is seen in 5% of healthy adults.1
The goal of medical management
Therapy is aimed at relieving pain and reducing inflammation. Other goals include protecting articular integrity, maintaining physical function, and controlling systemic involvement.
Among the treatment options is a class of drugs known as disease-modifying anti-rheumatic drugs (DMARDs). Cuprimine® (penicillamine) is classified as a DMARD, and appears able to alter the course of RA. It is believed to modify the inflammatory component of the disease.1
Important Safety Information
CUPRIMINE® (Penicillamine) is a chelating agent used in the treatment of Wilson's disease. It is also used to reduce cystine excretion in cystinuria and to treat patients with severe active rheumatoid arthritis unresponsive to conventional therapy. Physicians planning to use penicillamine should thoroughly familiarize themselves with its toxicity, special dosage considerations and therapeutic benefits. Penicillamine should never be used casually. Each patient should remain constantly under the close supervision of the physician. Patients should be warned to report promptly any symptoms suggesting toxicity. Penicillamine can cause fetal harm when administered to a pregnant woman, therefore except for the treatment of Wilson's disease or certain patients with cystinuria, use of penicillamine during pregnancy is contraindicated. Mothers on therapy with penicillamine should not nurse their infants. Patients with a history of penicillamine-related aplastic anemia or agranulocytosis should not be restarted on penicillamine. Because of its potential for causing renal damage, penicillamine should not be administered to rheumatoid arthritis patients with a history or other evidence of renal insufficiency. The use of penicillamine has been associated with fatalities due to certain diseases such as aplastic anemia, agranulocytosis, thrombocytopenia, Goodpasture's syndrome, and myasthenia gravis. Leucopenia and thrombocytopenia have been reported to occur up to five percent of patients during penicillamine therapy. Proteinuria and/or hematuria may develop during therapy and may be warning signs of membranous glomerulopathy which can progress to t nephritic syndrome. Intrahepatic cholestasis, toxic hepatitis and obliterative bronchiolitis have been reported. Onset of new neurological symptoms has been reported, or existing neurological symptoms have worsened. Most of the various forms of pemphigus have occurred during treatment with penicillamine. Some patients may experience a drug fever sometimes accompanied with a macular cutaneous eruption. Early and late rashes have occurred. Certain patients may develop a positive antinuclear antibody (ANA) test and some of these may show a lupus erythematosus-like syndrome. Some patients may develop oral ulcerations. Hypogeusia has been reported in some patients. Penicillamine should not be used in patients who are receiving concurrently gold therapy, antimalarial or cytotoxic drugs, oxyphenbutazone or phenylbutazone.
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Reference: 1. . Brewer GJ. Wilson's disease. In: Kasper DL, Fauci AS, Longo DL, eds. Harrison's Principles of Internal Medicine. New York. 16th ed. McGraw-Hill. 2005: 2313-15.
