D-penicillamine has been used to treat systemic sclerosis (scleroderma) for nearly two decades. Improvement in cutaneous fibrosis in patients treated with this drug has been documented in a number of uncontrolled studies (1). The effect of D-penicillamine on established visceral involvement due to systemic sclerosis, however, has not been examined as thoroughly. In a recent issue of Arthritis and Rheumatism, de Clerck et a1 (2) reported that prolonged use of D-penicillamine was beneficial in the treatment of pulmonary interstitial fibrosis due to systemic sclerosis. These results confirm the findings presented in a preliminary report from their group (3), as well as observations of Steen et a1 (4).
The first published findings on the effect of D-penicillamine on pulmonary function in systemic sclerosis were contradictory. Smiley and coworkers ( 5 ) were unable to show any improvement in 7 patients who were treated with 1-2 gm of D-penicillamine daily for 4-5 months. However, Broll et al (6) followed 5 scleroderma patients who received 500 mg of Dpenicillamine daily for 1.3-4.0 years, and they noted improvement in pulmonary function test results and clinical findings. The long duration of both drug administration and followup in the latter study could, conceivably, account for the results. A parallel circumstance is that of reduction in skin thickening after D-penicillamine therapy, which could be demon--From the Division of Rheumatology and Clinical Immunol-