D-penicillamine toxicity in Greek patients with rheumatoid arthritis: anti-Ro(SSA) antibodies and cryoglobulinemia are predictive factors.

Sixty-two consecutive patients, with rheumatoid arthritis (RA) who received D-penicillamine were studied retrospectively to identify predictive risk factors for D-penicillamine toxicity. Thirty-two developed side effects, while 30 did not. The clinical picture in both groups was similar, but the group with D-penicillamine toxicity was characterized by a high incidence of anti-Ro(SSA) antibodies (p less than 0.01) or circulating cryoglobulins (p less than 0.001). The presence of anti-Ro(SSA) antibodies was not correlated with the presence of circulating cryoglobulins (p greater than 0.5), while the coefficient of contingency (C) between anti-Ro(SSA) and cryoglobulins was 0.131. Men were predisposed to express more renal pathology (p less than 0.025), while anti-Ro(SSA) positive patients with RA more often expressed rashes (p less than 0.0001) and acute febrile reactions (p less than 0.05) than anti-Ro(SSA) negative patients. These observations should be considered when making therapeutic decisions at least for Greek patients with RA.