[Treatment by intra-articular injection].
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Biomedical subjects
Publications and source records attributed to E Munthe.
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Tolerance to D-penicillamine was studied prospectively over an 8-yr period in 318 patients with inflammatory rheumatic disorders. Adverse reactions, observed in 76% of patients, required permanent withdrawals in only 47% of the 318. Withdrawals could be reduced by lowering dosage and making increments extremely slowly. In 207 rheumatoid arthritis patients who had received gold thiomalate, adverse reactions to D-penicillamine were fewer than with the gold and, less often, caused permanent withdrawals. Of 164 nonresponders to gold thiomalate, 53% responded to D-penicillamine. Only 10% of nonresponders to D-penicillamine responded to gold thiomalate.
Measurement of glutathione (GSH) in consecutive blood samples from patients with rheumatoid arthritis (RA) revealed, in good responders to D-penicillamine, a 20% to 35% increase in erythrocyte-GSH (E-GSH) levels after 2 to 8 wk of treatment. Usually this rise predicted a clinical response some wk later. Nonresponders to D-penicillamine who did not show an increase in E-GSH could be converted to responders by receiving L-cysteine. E-GSH rose--prior to the clinical response--by up to 50% of pretreatment values. In RA patients with spontaneous changes in disease activity, E-GSH tended to decrease during relapses and increase before remissions.