Clinical Rheumatology

, Volume 7, Issue 3, pp 347–353 | Cite as

The clinical value of measuring immunoglobulins when assessing penicillamine therapy in rheumatoid arthritis

  • A. Williams
  • D. L. Scott
  • A. Greenwood
  • E. C. Huskisson


Immunoglobulins are often high in active rheumatoid arthritis and fall when treatment with a slow-acting anti-rheumatic drug is instituted. We assessed the value of monitoring immunoglobulins during penicillamine therapy; 145 patients were followed for up to 5 years, IgA, IgM and IgG levels were compared to 12 other clinical and laboratory variables on 903 occasions. Mean levels of IgA and IgG fell by 10–30%. These changes were less than with ESR or clinical measures such as articular index and duration of morning stiffness. Immunoglobulin levels showed weak correlations with other variables. Only a small number of patients had hypogammuglobulineamia. Initially, 5 cases had low IgA with subsequent falls in 3 more. Initially, 2 cases had low IgG with subsequent falls in 5 more. No patients had low IgM levels. These changes seemed clinically irrelevant. Radiological progression was related to IgA levels. Patients with persistently high rates of radiological progression had persistently higher serum IgA. We conclude that IgM gives the most “acute phase” pattern of response. IgA gives more theoretically interesting information, especially concerning radiological progression. There is only a limited amount of clinically valuable information gained from measuring immunoglobulins.

Key words

Rheumatoid Arthritis Penicillamine Immunoglobulins 


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  1. 1.
    Claman, H.N., Merrill, D. Serum immunoglobulins in rheumatoid arthritis. J Lab Clin Med 1966, 67, 850–861.PubMedGoogle Scholar
  2. 2.
    Veys, E.M., Claessens, H.E., Serum levels of IgG, IgM and IgA in rheumatoid arthritis. Ann Rheum Dis 1968, 27, 431–440.PubMedGoogle Scholar
  3. 3.
    Goel, K.M., Logan, R.W., Barnard, W.P., Shanks, R.H. Serum immunoglobulins and beta 1c/beta 1A globulin concentrations in juvenile rheumatoid arthritis. Ann Rheum Dis 1974, 33, 35–38.PubMedGoogle Scholar
  4. 4.
    Huskisson, E.C., Berry, H. Some immunological changes in rheumatoid arthritis among patients receiving penicillamine and gold. Postgrad Med J 1974, 50, Suppl 2, 59–61.Google Scholar
  5. 5.
    Gottieb, N.L., Kiem, I.M., Penneys, N.S., Schultz, D.R. The influence of chrysotherapy on serum protein and immunoglobulin levels, rheumatoid factor, and anti-epithelial antibody titres. J Lab Clin Med 1975, 86, 962–972.PubMedGoogle Scholar
  6. 6.
    Stanworth, D.R., Johns, P., Davies, D.F., Wilkinson, B. The effects of long-term D-penicillamine treatment on serum immunoglobulin and antibody levels in rheumatoid arthritis. In: Penicillamine Research in Rheumatoid Disease. Oslo, Fabritius; 1977, 132–145.Google Scholar
  7. 7.
    Vischer, T. Measurements of humoral immunity during treatment with levamisole in RA— a review. J Rheumatol 1978, Suppl 4, 49–53.Google Scholar
  8. 8.
    Lorber, A., Simon, T., Leeb, J., Peter, A., Wilcox, S. Chrysotherapy. Suppression of immunoglobulin synthesis. Arthritis Rheum 1978, 21, 785–791.PubMedGoogle Scholar
  9. 9.
    Stanworth, D.R., Hunneyball, I.M. Influence of D-penicillamine treatment on the humoral immune system. Scand J Rheumatol, 1979, Suppl 28, 37–46.Google Scholar
  10. 10.
    Bacon, P.A., Blake, D. R., Alexander, G.J.M., Hall, N.D. Immunological parameters during D-penicillamine therapy. In: Modulation of Autoimmunity and Disease. Ed: R.N. Maini, H. Berry, Praeger, Eastbourne; 1981, 10–15.Google Scholar
  11. 11.
    Stanworth, D.R., Johns, P., Williamson, N., Shadforth, M., Davies, D.F., Thompson, R. Drug induced IgA deficiency in rheumatoid arthritis. Lancet 1977, 1001.Google Scholar
  12. 12.
    Johns, P., Davies, D.F., Hawkins, C.E. et al. IgA deficiency in patients with rheumatoid arthritis treated with D-penicillamine or gold. Ann Rheum Dis 1978, 37, 289.Google Scholar
  13. 13.
    Delamere, J.P., Farr, M., Grindulis, K.A. Sulphasalazine induced selective IgA deficiency in rheumatoid arthritis. Br Med J 1983, 286, 1547–1548.Google Scholar
  14. 14.
    So, A.K.L., Pesknett, S.A., Webster, A.D.B. Hypogammoglobulineamia associated with gold therapy. Ann Rheum Dis 1984, 43, 581–582.PubMedGoogle Scholar
  15. 15.
    Farr, M., Tunn, E., Bacon, P.A., Smith, D.H. Hypogammaglobulinaemia and thrombocytopenia associated with sulphasalazine therapy in rheumatoid arthritis. Ann Rheum Dis 1985, 44, 723–724.Google Scholar
  16. 16.
    Mybuyi, J.M., Dequeker, J., Francx, L. IgA deficiency and drug induced IgA deficiency in rheumatoid arthritis. J Rheumatol, 1983, 10, 829–831.PubMedGoogle Scholar
  17. 17.
    Van-Riel, P.L., Van de Putte, L.B., Grisnan, F.W., de Waal, R.M. IgA deficiency during aurothioglucose treatment. A case report. Scand J Rheumatol 1984, 13, 334–336.PubMedGoogle Scholar
  18. 18.
    Ritchie, D., Boyle, J.A., McInnes, J.M., et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968, 37, 393–406.PubMedGoogle Scholar
  19. 19.
    Larsen, A., Dale, K., Eck, M. Radiolographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol [Diagn] 1977, 18, 481–491.Google Scholar
  20. 20.
    Scott, D.L., Dawes, P.T., Fowler, P.D., et al. Anti-rheumatic drugs and joint damage in rheumatoid arthritis. Q J Med 1985, 54, 49–59.PubMedGoogle Scholar
  21. 21.
    Wright, V., Dixon, J.S., Bird, H.A., Therapeutic significance of laboratory results in rheumatic disease. Semin Arthritis Rheum 1985, 15, 8–13.PubMedGoogle Scholar
  22. 22.
    Tietsson, I., Withrington, R.H., Seifert, M.H., Valdimarsson, H. Prospective study of early rheumatoid arthritis. 1. Prognostic value of IgA rheumatoid factor. Ann Rheum Dis 1984, 43, 673–678.PubMedGoogle Scholar
  23. 23.
    Withrington, R.H., Seifert, M.H. Predominant wrist disease in rheumatoid arthritis associated with high concentration of IgA rheumatoid factor. Br Med J 1985; 291: 1388.Google Scholar
  24. 24.
    Wunska-Willoch, H., Thompson, K., Young, A., Corbett, M., Shipley, M., Hay, F. IgA and IgM rheumatoid factors in rheumatoid arthritis. Br J Rheumatol 1987, Suppl 1, 4.Google Scholar
  25. 25.
    Westedt, M.L., Daha, M.R., Baldwin, W.M., Stijon, T., Cats, A. Serum immune complexes containing IgA appear to predict erosive arthritis in a congitudual study in rheumatoid arthritis. Ann Rheum Dis 1986, 45, 809–815.PubMedGoogle Scholar
  26. 26.
    McConkey, B., Crockson, A.P., Crockson, R.A. The effects of some anti-rheumatic drugs on the acute phase proteins in rheumatoid arthritis. Q J Med 1973, 42, 785–791.PubMedGoogle Scholar
  27. 27.
    Dixon, J.S., Bird, H.A., Sitton, N.G., C-reactive protein in the serial assessment of disease activity in rheumatoid arthritis. Scand J Rheumatol 1984, 13, 39–44.PubMedGoogle Scholar
  28. 28.
    Grindulis, K.A., Scott, D.L., Robinson, M.W., Bacon, P.A., McConkey, B. Serum amyloid A protein during a treatment of rheumatoid arthritis with second line drugs. Br J Rheumatol 1985, 24, 158–163.PubMedGoogle Scholar

Copyright information

© Acta Medica Belgica 1988

Authors and Affiliations

  • A. Williams
    • 2
  • D. L. Scott
    • 1
  • A. Greenwood
    • 1
  • E. C. Huskisson
    • 1
  1. 1.Department of RheumatologySt. Bartholomew's HospitalLondonUK
  2. 2.Clinical ChemistrySt. Bartholomew's HospitalLondonUK

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