The oral
gold salt auranofin, 6 mg per day, was compared with oral
d-penicillamine, 500 mg per day, in a single-blind trial in 40 patients suffering with definite or classic
rheumatoid arthritis. The patients were randomly allocated into the two therapeutic regimens (19 patients
auranofin; 21 patients
d-penicillamine) and monitored at a minimum of four-week intervals during the first year of treatment. Significant diminution in rheumatoid disease activity, as assessed by numerous clinical and laboratory parameters, was observed in both the
auranofin- and
penicillamine-treated groups. No significant differences existed for these parameters between the two groups, either initially or at the end of the trial period. Ten patients were lost from the trial over the 52-week period. Three subjects were withdrawn from the
auranofin-treated group (increasing severity of
rheumatoid arthritis at four weeks; severe
diarrhea at four weeks; probable
drug-related erosive
gastritis at 40 weeks). Seven subjects were permanently withdrawn from the
penicillamine-treated group (four, skin rashes four to eight weeks; one, heavy
proteinuria at 24 weeks; one, therapeutic failure at 32 weeks; one, compliance failure at eight weeks), and treatment was temporarily withheld in three further patients because of
thrombocytopenia (two) and
proteinuria (one). We conclude that both drugs are effective in
rheumatoid arthritis and that the lesser toxicity with
auranofin will make it a valuable addition to our therapeutic armamentarium.