Osteoporosis in the rheumatoid hand--the effects of treatment with D-penicillamine and oral gold salts.

Osteoporosis is a common and important feature of rheumatoid disease which can be further influenced by the treatment administered. D-penicillamine, a lathyritic agent, can also theoretically hasten the osteoporotic process through its effect on collagen metabolism. In the present study the effects of the long-term second-line drugs D-penicillamine and oral gold (Auranofin) on bone density are presented. All the patients studied lost bone mineral over the 3-year period, but continuous D-penicillamine therapy for 1 year reversed this trend. Oral gold did not have the same effect. Measurements of bone density are an accurate indirect measurement of hand function, and there is a good correlation between hand function and the progress of osteoporosis. It is therefore suggested that treatment with D-penicillamine reverses the tendency to lose bone mineral improving synovitis, thus leading to improved hand function.