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  • Title: [D-penicillamine induced myasthenic syndromes in rheumatoid arthritis. Two cases (author's transl)].
    Author: Rodat O, Hamelin JP, Rossard A, Cottin S, Cler JM, Rodat G, Lemouroux P.
    Journal: Nouv Presse Med; 1981 May 02; 10(20):1645-8. PubMed ID: 7255126.
    Abstract:
    The authors report on 2 personal cases, and review 48 published cases of myasthenia induced by D-penicillamine (D-P) treatment in patients with rheumatoid arthritis. The clinical symptoms were not different from those of myasthenia gravis, and no correlation could be found between the total cumulative dose of D-P and the onset on the myasthenic syndrome. In 71% of the patients the neurological deficiency regressed after D-P was withdrawn, but in some cases anticholinesterase treatment had to be continued and thymectomy was contemplated. The most remarkable biological abnormalities were anti-striational antibodies (found in 58% of the cases) and anti-acetylcholine receptors antibodies (found in 4 out of 7 patients tested). These findings are in favour of a genuine myasthenia and against a myasthenic syndrome due to neuro-muscular blockade. While the mechanisms underlying the emergence of these antibodies remains unknown, their presence throws new light on immunological disorders in rheumatoid arthritis.
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