Sequential gold and penicillamine therapy in rheumatoid arthritis.

Ninety patients with rheumatoid arthritis who had received courses of gold followed by penicillamine for their disease were evaluated to determine the predictiveness of a certain response or adverse reaction to gold for the same response or adverse reaction to penicillamine. Most patients who were considered gold-responders also responded to penicillamine, and most patients who did not respond to gold responded to penicillamine as well. Regarding toxicity, gold reactions did not predict reactions to penicillamine except that that patients with gold-induced proteinuria were at a higher risk for development of proteinuria during penicillamine therapy (p less than 0.001), and this usually occurred within the first six months of treatment. Patients with penicillamine-associated mucocutaneous reactions tended to have low gamma globulin levels (p less than 0.05) and were less likely to have subcutaneous nodules (p less than 0.05).