Comparison of Penicillamine and Gold Treatment in Early Rheumatoid Arthritis

Abstract

In a series of 100 adult patients with definite rheumatoid arthritis of at most 3 years' duration and with no previous penicillamine, gold or systemic corticosteroid treatment, 50 patients were treated with D-penicillamine and 50 with gold for one yar. The dose of penicillamine was 600 mg daily. Sodium aurothiomalate was given 50 mg weekly up to a total of 13 mg/kg and thereafter 50 mg once a month. In both treatment groups a statistically significant decrease in the number of painful and/or swollen joints, an increase in haemoglobin and a decrease in ESR, serum ceruloplasmin-, alpha1-acid glycoprotein-, IgG-, IgM- and IgA levels was observed. All the changes in these clinical and laboratory tests were of the same degree in both treatment groups. In the penicillamine group 12 out of 20 seropositive patients became seronegative and in another 5 the Waaler-Rose titre dropped clearly. In the gold group, 7 out of 16 seropositive patients became seronegative, and the Waaler-Rose titre dropped in another 5. An equal increase in the number of eroded joints in hands and toes was seen in the penicillamine and the gold group. Penicillamine was discontinued because of side effects in 13 patients (26%), and gold treatment in 15 (30%). Proteinuria and/or haematuria were the most common causes of discontinuation in the penicillamine group.

Discriminatory indices of response of patients with rheumatoid arthritis treated with D-penicillamine.

“…2), the patients' anaemia failed to respond significantly to penicillamine treatment whereas previous reports have indicated significant improvement during treatment. 25 32 The concurrent aspirin therapy may be responsible for this lack of response. However, an enteric coated preparation was used, minimising gastric bleeding, and the dose was reduced over the 24-week period.…”

Immunological Effects of Biarison® in the Treatment of Rheumatoid Arthritis and Systemic Lupus Erythematosus:A Preliminary Report

“…These effects which are in part statistically significant are paralleled by a drop in the ESR and by clinical improvement. Similar effects on immunological parameters are usually seen only in patients treated with gold salts or D-penicillamine (9).…”

“…The so-called long-term or specific agents, such as gold salts (9), D-penicillamine (91, and antimalarial drugs, are capable of suppressing rheumatoid inflammation. However, their use is often limited by severe side effects.…”

Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis

“…A total of 29 interventions among 132 randomized clinical trials (RCTs) represented by 130 publications (mean [range], 71.0% [27.0%-100%] females in studies; mean [range] of ages in studies, 53 [36-70] years) were identified, which included 13 260 patients with rheumatoid arthritis. The number of studies with measured outcomes was 118 studies for TJC, 116 studies…”

“…For our primary analysis of all 132 studies (represented by 130 publications) we used the most frequently reported outcome, TJC. This included imputed TJC values for studies that did not measure TJC (eMethods 5 in Supplement 1), denominated TJCi.…”