D-penicillamine in rheumatoid arthritis.

D-penicillamine (D-pen) has gained wide-spread use as a potent suppressor of disease activity in rheumatoid arthritis (RA) and juvenile chronic arthritis (JCA). The drug has been established for antirheumatotd therapy on the basis o f a considerable number o f comparative clinical studies o f D-pen treatment versus placebo or other disease modifying antirheumatic drugs (DMARDs). Despite the positive outcome o f these trials, no comprehensive understanding of its mode of action has emerged. Development of more differentiated drug strategies, construction o f combination treatment protocols and generation of agents with defined target speclficities may imply a more favourable benefit to risk ratio In the management of RA.