Rheumatoid arthritis with secondary amyloidosis and malabsorption syndrome: Effect of D-penicillamine

Abstract

Described herein is a case of rheumatoid arthritis with generalised secondary amyloidosis in which the malabsorption syndrome was one of the most prominent features. This appears to be the third such documented case. The malabsorption syndrome was proved by biopsy to be associated with the presence of amyloid deposits in stomach, jejunum and rectum. The patient failed to respond to conventional treatments, and in view of the qualitatively increased macroglobulins it was decided to use d-penicillamine in a dosage of 1.8 gm. per day. Penicillamine therapy appeared to halt the steatorrhoea and to improve the patient's general sense of well-being, without modifying some of the other parameters of malabsorption. There was a marked rise in the haemoglobin level which appeared to be due to more adequate utilisation of iron stores. The serum albumin and gamma globulin returned to more normal levels during the course of treatment. Alpha 2 globulins appeared to return towards normal for a while but concomitantly with an increase in serum urea returned to their past levels. The expected changes in the macroglobulins on immunoelectrophoresis were not observed and the Rose-Waaler test became positive again during the treatment.