Perivascular infiltration in normal skin of patients with rheumatoid arthritis: association with rheumatoid factors and HLA-DR antigens.

The relation between immunohistological findings in biopsy specimens of apparently normal skin, HLA antigens, and rheumatoid factors (RF) was studied in 120 patients with rheumatoid arthritis (RA), selected for treatment with D-penicillamine. Perivascular infiltration (PVI) of more than three mononuclear cells was present in 77 (68%) of 114 patients, accompanied usually by the presence of IgM or C3, or both, in immunofluorescence studies. The number of perivascular cells was associated significantly with the titre of circulating RF. A weak relation of both perivascular cellular infiltration and RF with HLA-DR3 and DR4 did not reach statistical significance. It is concluded that the histological presence of perivascular inflammation is associated mainly with deposition of RF. It is suggested that the first is merely an epiphenomenon of the latter. PVI was not prognostic for the occurrence of the clinical syndrome of rheumatoid vasculitis. For practical purposes skin biopsies do not appear to be useful in the evaluation of individual patients with RA.

D-penicillamine in patients with rheumatoid arthritis. Serum levels, pharmacokinetic aspects, and correlation with clinical course and side effects.

After administration of D-penicillamine to patients with rheumatoid arthritis, measurements of serum level and urinary excretion showed half-life times of 1.6 hours in the rapid phase and 4-6 days in the slow phase. The latter evidence suggests that tissue pooling occurs. With a dosage of 750 mg/day, basic serum levels of 100 microM are gradually reached. Serum D-penicillamine levels were shown to be the same for patients who responded well to treatment, those who did not respond, and for patients who had adverse side effects as well as those who had none. Intestinal resorption decreased when D-penicillamine was taken close to meals and was greatly reduced by iron preparations.