A biochemical comparison of alclofenac and D-penicillamine in rheumatoid arthritis. Ann Rheum Dis

SUMMARY In view of the claim that alclofenac has a specific antirheumatoid action a detailed biochemical study has been made over a 6-month period of 2 groups of patients with rheumatoid arthritis receiving either alclofenac or D-penicillamine for the first time. We found no biochemical evidence and little clinical evidence that alclofenac had a 'penicillamine-like ' effect in rheumatoid arthritis. Alclofenac * (4-allyloxyl-3-chlorophenylacetic acid) is a nonsteroidal anti-inflammatory agent derived from arylacetic acid. Biochemical studies have suggested, however, that this drug may have a more specific action in rheumatoid arthritis, fundamentally influencing the disease process. This evidence comes from fall in erythrocyte sedimentation rate (ESR), " 2 fall in immunoglobulins and latex agglutination titre but not in sheep cell agglutination test (SCAT) titre,3 rise in free plasma tryptophan, ' and a rise in serum sulphydryl levels.4 As part of a long-term study in which we are attempting to define biochemical profiles of response in patients with rheumatoid arthritis treated for the first time with 'specific ' drugs we have compared the majority of these biochemical changes in patients treated either with D-penicillamine or with alclo-fenac. We report these results, which are at variance with those previously described. Patients and methods All patients had classical or definite rheumatoid arthritis (American Rheumatism Association cri-teria) and moderate or severe disease activity judged by the presence of at least 3 out of: (i) tenderness of 6 joints or more; (ii) swelling of more than 3 joints; (iii) morning stiffness>45 minutes; (iv) articular index5>20; (v) ESR>28 mm/h.' Patients who had received gold, D-penicillamine, hydroxychloroquine, immunosuppressive drugs, o