Second line therapy in rheumatoid arthritis--a four year prospective study.

One hundred and twenty-three rheumatoid patients were commenced on one of the three second-line agents: sodium aurothiomalate (GST), penicillamine (P), or levamisole (L). After four years, 39% of the GST group, 20% of the penicillamine group, and 8% of the levamisole group remained on the original agent. Fifty five % of patients, however, were receiving some second-line agent at four years, and patients showed an improvement in inflammatory indices irrespective of whether or not they were still receiving second-line therapy. It is unclear whether this improvement reflects the natural history of the disease, or the fact that regular clinic attendance identifies patients who require further second-line therapy following cessation of the initial agent.