Cyclophosphamide, gold and penicillamine--disease-modifying drugs in rheumatoid arthritis--tailored dosage and ultimate success.

Gold appears to be the disease-modifying drug of first choice for two reasons: response and absence of long-term toxicity. Although cyclophosphamide produces results as good or better than gold, the possible long-term toxicity outweighs the clinical benefit except in the unusual case. Penicillamine appears to be an acceptable drug of second choice.