Pure red cell aplasia caused by D-penicillamine treatment of rheumatoid arthritis

Article Abstract:

The use of D-penicillamine for treating rheumatoid arthritis has been associated with the development of blood and bone marrow disorders. In fact, the incidence of complications resulting from treatment with this drug has been reported to be as high as 60 percent. Other agents used for treating arthritis, such as the nonsteroidal anti-inflammatory drugs, gold salts or azathioprine, have been implicated in causing red cell aplasia, in which red blood cell production totally ceases. This article describes the case report of a 40-year-old woman who developed red cell aplasia while she was being treated with D-penicillamine for rheumatoid arthritis. She had a two-year history of rheumatoid arthritis and had been treated with a variety of different nonsteroidal anti-inflammatory drugs. She began treatment with D-penicillamine at a dose of 250 milligrams/day. After therapy was initiated, blood tests showed that her red and white blood cell counts were normal, and her arthritis began to improve. Almost one year later, her arthritis suddenly became worse and the dose of D-penicillamine was increased to 500 milligrams/day. This improved her symptoms associated with the arthritis, but it greatly reduced the number of red blood cells. A bone marrow sample revealed that the specific type of cells that mature to become red blood cells were not present. She was diagnosed as having red cell aplasia caused by D-penicillamine. Treatment with D-penicillamine was stopped and treatment with prednisone was begun. After three months of the new treatment, red blood cell production was restored and the woman made a full recovery from the red cell aplasia. It is recommended that patients being treated with D-penicillamine have routine blood tests to monitor red blood cell production. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pure red cell aplasia

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Fatal aplastic anaemia and liver toxicity caused by D-penicillamine treatment of rheumatoid arthritis

Article Abstract:

The drug penicillamine is used to treat rheumatoid arthritis (RA), a joint disease characterized by inflammation of the joints, stiffness, swelling, enlargement of the cartilage, and pain. Although penicillamine is an effective treatment, it may cause serious side effects, including blood disease, abnormal bone marrow development (aplasia), and toxic effects in the liver. A case is described of a 65-year-old woman with RA who was treated with penicillamine. Three months after treatment began, the patient developed aplastic anemia, a decrease in red blood cells due to abnormal development or destruction of the bone marrow. Two days after the penicillamine was withdrawn, the patient developed jaundice (the yellowing of skin, whites of eyes, mucous membranes, and body fluids due to deposition of bile pigment). Excess bilirubin in the blood may result from blockage of bile passages, destruction of red blood cells, or abnormal liver function. Despite treatment with corticosteroids, lithium carbonate, and blood transfusions, her condition deteriorated to kidney failure, and the patient died. The toxic mechanism of penicillamine in bone marrow is unknown; it may be a result of an unusual response by a patient or related to penicillamine interference in the production of deoxyribonucleic acid (DNA), the genetic material of the cell. Bone marrow toxicity may be more common in RA patients who have been previously treated with gold and in the elderly. This case is unusual in that penicillamine caused both liver toxicity and bone marrow aplasia in the same patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Liver, Bone marrow

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Minocycline induced arthritis associated with fever, livedo reticularis, and pANCA

Article Abstract:

Some patients using minocyline to treat acne may, in rare instances, experience arthritis symptoms. Three patients aged 19, 20, and 22 years treated with minocyline for several years in mid-adolescence developed signs of arthritis including inflamed joints and blood vessels, fever, and elevated blood levels of anticytoplasmic and antimyeloperoxidase antibodies. Evidence of this condition disappeared within 24 hours when the treatment was stopped and returned when the treatment was re-started.

Arthritis, Acne, Minocycline

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