title: Second line (disease modifying) treatment in rheumatoid arthritis: which drug for which patient?
abstract: OBJECTIVE
  The objectives were to assess (a) the comparative merits of commonly used disease modifying drugs in the treatment of rheumatoid arthritis (RA) and (b) the influence of age, gender, and disease duration on the outcome of treatment.
  
  
  METHODS
  Collected analysis (meta-analysis) was performed on results obtained during the first year of treatment in 1140 patients with RA treated with gold, penicillamine, sulphasalazine, or auranofin from a single centre.
  
  
  RESULTS
  Gold, penicillamine, and sulphasalazine performed similarly, with about 60% of patients continuing to receive each of these drugs for at least one year. Neither gender nor age had an influence on the response to treatment, but patients with a longer disease duration showed a greater tendency to stop treatment. The median percentage improvement was 33% in visual analogue pain score and 50% in erythrocyte sedimentation rate.
  
  
  CONCLUSIONS
  Routine use of these drugs should at least equal these results. Any new drug should either be substantially less toxic or at least as efficacious.
authors.affiliation: Centre for Rheumatic Diseases, Glasgow Royal Infirmary, United Kingdom.
authors.forename: H A
authors.initials: HA
authors.lastname: Capell
authors.forename: D R
authors.initials: DR
authors.lastname: Porter
authors.forename: R
authors.initials: R
authors.lastname: Madhok
authors.forename: J A
authors.initials: JA
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D001310:Auranofin / Q000627:therapeutic use; D001799:Blood Sedimentation; D005260:Female; D006046:Gold / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010396:Penicillamine / Q000627:therapeutic use; D012737:Sex Factors; D012460:Sulfasalazine / Q000627:therapeutic use
chemical_list: D001310:Auranofin; D012460:Sulfasalazine; D006046:Gold; D010396:Penicillamine