• D. L. Scott


In the last ten years there have been a number of placebo-controlled studies of penicillamine in rheumatoid arthritis. All of these show it to be better than placebo.

Prospective controlled studies and uncontrolled evaluations of the drug in clinical practice show that it reduces the degree of acute synovial inflammation, reduces the elevated ESR of active disease, and also lowers other acute-phase changes. It has more debatable effects on immunological abnormalities and other variables such as glutathione and sulphydryl levels, but these all show some evidence of improvement. There is little direct evidence that it reduces the chronic progressive joint destruction of rheumatoid synovitis, which can be measured radiologically. It often causes adverse reactions, is often ineffective, and although it improves many variables these do not often return completely to normal. There is minimal evidence that it actually changes the long-term outcome in rheumatoid disease.

Interpretation of the studies indicates that penicillamine is a useful antirheumatic drug. The question is how to improve upon therapy. There are several methods open, including the use of combinations of second-line drugs, or starting treatment with drugs like penicillamine very early in the course of the disease. Will further placebo-controlled trials help resolve these questions or do we need another type of approach? As all the traditional studies have a very high dropout rate their conclusions have certain limitations and there is a need for a different type of study. The value of the traditional approach to testing drugs like penicillamine is clearly very limited.


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© D. H. Goddard and R. C. Butler 1984

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  • D. L. Scott

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