Accelerated nodulosis is a recognized complication of methotrexate (MTX) th
erapy in rheumatoid arthritis (RA), We describe 3 patients with accelerated
nodulosis treated with D-penicillamine (D-Pen) while continuing MTX, The c
ombination of D-Pen with MTX therapy resulted in regression of subcutaneous
nodules in all patients, disappearance of pulmonary nodules in one patient
, and resolution of vasculitic lesions in 2 patients. Clinical response was
observed within the first few weeks of therapy and usually required modera
te doses (500 mg/day), Our observations suggest that addition of D-Pen to M
TX therapy can be an alternative therapeutic option for accelerated nodulos
is in patients with RA.