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Neuromuscular transmission in rheumatoid arthritis, with and without penicillamine treatment

Electroneuromyographic Laboratory and Department of Neurology (Dr. Albersi, the Department of Internal Medicine, Division of Rheumatology (Dr. Bealsi, Department of Physical Medicine and Rehabilitation (Dr. Albers and Mr. Levine), University of Michigan Medical Center, Ann Arbor, MI.

Address correspondence and reprint requests to Dr. Albers, Department of Neurology, B4917, C.F.O.B., Box 051, University of Michigan Medical Center, Ann Arbor, MI 48109.

Electroneuromyographic studies were performed on patients with rheumatoid arthritis, some of whom were receiving penicillamine, to determine whether a subclinical defect of neuromuscular transmission existed. There were no significant differences between patients and controls with respect to nerve conduction studies or repetitive ulnar nerve stimulation, Four patients (three receiving penicillamine) demonstrated mild neurogenic changes distally on needle electromyography. Mean jitter was slightly higher for patients receiving penicillamine than in other patients or controls, but the differences were not significant. No significant correlations existed between any of the studies and daily, cumulative, or average penicillamine dosage. A significant positive correlation (p <0.001) existed between jitter and duration of disease in patients receiving penicillamine. Results were consistent with the hypothesis that penicillamine predisposes certain individuals to develop myasthenia gravis rather than interfering directly with neuromuscular transmission.