Mark B. Skeen, MD
To the Editors: The review by Stremmel and colleagues (1) is informative and provides a significant analysis of the presentation, evaluation, and long-term course of Wilson disease using current therapies. Their conclusion that the calculated serum free-copper concentration is the most reliable finding for the initial diagnosis and is the best indicator of the effectiveness of copper-reducing therapy is noteworthy. Of specific interest is the significantly reduced incidence of severe side effects of D-penicillamine compared with the incidence reported in previous studies of its use in rheumatoid arthritis, systemic sclerosis, and primary biliary cirrhosis. Current package labeling states "Because of
Skeen MB. Wilson Disease—Penicillamine Therapy and Late Presentation. Ann Intern Med. ;116:424–425. doi: 10.7326/0003-4819-116-5-424_2
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Published: Ann Intern Med. 1992;116(5):424-425.
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