A study of the combined effect of ACTH(gel) and D-penicillamine on the functional disability of patients with rheumatoid disease.

Over a 6-year period, in 48 patients given concomitant D-penicillamine and ACTH(gel), the rapid induction of remission of the rheumatoid disease as judged by return to work in full and gainful employment was achieved in 77% within 1 month, in 71% by the end of 3 years, by which time 89% had achieved either Steinbrocker functional class I or II. Side effects were strikingly low in our patients with this regime, except for nephrotoxicity (10%); skin rash, dysgeusia and thrombocytopenia in 1 patient only and all patients were free of any gastrointestinal upset. Subsequent treatment of the failures with gold produced an overall remission rate of 90% in 3 years.