Outcome of attempts to treat rheumatoid arthritis with gold, penicillamine, sulphasalazine, or dapsone

SUMMARY The outcome of attempts to continue treatment indefinitely with either gold, penicil-lamine, sulphasalazine, or dapsone was studied in 240 patients with rheumatoid arthritis (RA). The usual reason for discontinuing treatment was the occurrence of an adverse effect. This led to 53% of patients stopping gold, 33 % sulphasalazine, 32 % penicillamine, and 17 % dapsone. The next most frequent reason was that the drug was ineffective, leading to discontinuation in 37 % of patients havingdapsone, 24 % sulphasalazine, 19 % pencillamine, and 16 % gold. Otherreasonsfor stopping treatment were infrequent. The high discontinuation rate of these drugs over 2 years in part accounts for the conflict of opinion on whether they can alter the course of RA; their efficacy must to a large extent be governed by their acceptibility. In rheumatoid arthritis (RA) the effects of 'remission-inducing drugs ' (RIDs) have often been studied over periods of 6 to 12 months. In this time some drugs, notably gold ' and penicillamine,2 influ-ence the disease favourably. Less is known about the effects of more prolonged treatment. Gold and penicillamine, for example, have seldom been studied for periods exceeding 18 months and rarely compared with each other or with sulphasalazine (SAS)3 or dapsone. ' We describe a comparison between these 4 drugs with emphasis on how long treatment could be continued. Patients and methods We studied 240 outpatients, 179 women and 61 men, with classical or definite RA (ARA criteria). They comprised all those treated by us with gold, penicil-lamine, SAS, or dapsone for the first time betwee