Rheumatology and Rehabilitation, 1977, 16, 223
PENICILLAMINE IN RHEUMATOID ARTHRITIS: WOUND HEALING, SKIN THICKNESS AND OSTEOPOROSIS* BY D. SCHORN AND A. G. MOWAT Rheumatology Unit, Nuffield Orthopaedic Centre, Oxford
/?/?-dimethylcysteine, has a number of actions that may explain its success in the treatment of rheumatoid arthritis (Mowat and Huskisson, 1975). The drug affects collagen metabolism in vivo and in vitro and although this may not be the basis of its therapeutic effect, it has caused concern with regard to long-term usage. It chiefly prevents the normal maturation of soluble collagen into the insoluble, polymerized form that is present in the fibres (Francis and Mowat, 1974; Harris, Jaffe and Sjoerdsma, 1966). It is this effect that is of value in the treatment of scleroderma (Herbert et al., 1974). Skin collagen studies after penicillamine treatment in patients with rheumatoid arthritis have shown a decrease in total collagen, an increase in the salt-soluble fraction, an increase in the more soluble minor polymeric collagen fraction, and a decrease in the major proportion of polymeric collagen (Francis and Mowat, 1974). These changes are caused by inhibition of the normal cross-linking of collagen. Penicillamine also inhibits protein synthesis, including that of collagen (Kivirikko and Risteli, 1976). These effects of the drug on collagen could theoretically lead to an exaggeration of the skin thinning that occurs in patients with rheumatoid arthritis and impair wound healing after surgical treatment. Further, generalized and periarticular osteoporosis are features of rheumatoid disease; since the collagen content and structure of bone are important factors in determining the extent of any osteoporosis, penicillamine treatment could theoretically also accelerate this process. PENICILLAMINE,
* Paper read at the Annual Meeting of the British Association for Rheumatology and Rehabilitation, London April 1977. Requests for reprints to Dr. D. Schorn. 223
Downloaded from http://rheumatology.oxfordjournals.org/ at Yale University on June 29, 2015
SUMMARY D-PeniciUamine alters the normal metabolism of collagen by inhibiting cross-linking and protein synthesis. This could affect wound healing, accelerate skin thinning and possibly exaggerate the osteoporosis of rheumatoid disease. The mean time to wound healing after 42 orthopaedic surgical operations in 21 patients treated with penicillamine was 19.8 (±13.1) days. Compared with an earlier study, these results suggest that the drug has a comparable effect on wound healing to corticosteroids given for three years. Skinfold thickness over the fourth metacarpal of the dominant hand was measured in 28 cases before and during penicillamine treatment. There was a significant decrease both in the first and second four-month periods of treatment (P
PENICILLAMINE IN RHEUMATOID ARTHRITIS: WOUND HEALING, SKIN THICKNESS AND OSTEOPOROSIS* BY D. SCHORN AND A. G. MOWAT Rheumatology Unit, Nuffield Orthopaedic Centre, Oxford
/?/?-dimethylcysteine, has a number of actions that may explain its success in the treatment of rheumatoid arthritis (Mowat and Huskisson, 1975). The drug affects collagen metabolism in vivo and in vitro and although this may not be the basis of its therapeutic effect, it has caused concern with regard to long-term usage. It chiefly prevents the normal maturation of soluble collagen into the insoluble, polymerized form that is present in the fibres (Francis and Mowat, 1974; Harris, Jaffe and Sjoerdsma, 1966). It is this effect that is of value in the treatment of scleroderma (Herbert et al., 1974). Skin collagen studies after penicillamine treatment in patients with rheumatoid arthritis have shown a decrease in total collagen, an increase in the salt-soluble fraction, an increase in the more soluble minor polymeric collagen fraction, and a decrease in the major proportion of polymeric collagen (Francis and Mowat, 1974). These changes are caused by inhibition of the normal cross-linking of collagen. Penicillamine also inhibits protein synthesis, including that of collagen (Kivirikko and Risteli, 1976). These effects of the drug on collagen could theoretically lead to an exaggeration of the skin thinning that occurs in patients with rheumatoid arthritis and impair wound healing after surgical treatment. Further, generalized and periarticular osteoporosis are features of rheumatoid disease; since the collagen content and structure of bone are important factors in determining the extent of any osteoporosis, penicillamine treatment could theoretically also accelerate this process. PENICILLAMINE,
* Paper read at the Annual Meeting of the British Association for Rheumatology and Rehabilitation, London April 1977. Requests for reprints to Dr. D. Schorn. 223
Downloaded from http://rheumatology.oxfordjournals.org/ at Yale University on June 29, 2015
SUMMARY D-PeniciUamine alters the normal metabolism of collagen by inhibiting cross-linking and protein synthesis. This could affect wound healing, accelerate skin thinning and possibly exaggerate the osteoporosis of rheumatoid disease. The mean time to wound healing after 42 orthopaedic surgical operations in 21 patients treated with penicillamine was 19.8 (±13.1) days. Compared with an earlier study, these results suggest that the drug has a comparable effect on wound healing to corticosteroids given for three years. Skinfold thickness over the fourth metacarpal of the dominant hand was measured in 28 cases before and during penicillamine treatment. There was a significant decrease both in the first and second four-month periods of treatment (P
