Six trials with a total of 425 patients randomised to penicillamine and 258 randomised to placebo were included in a Cochrane review . A statistically significant benefit was observed for D-penicillamine whe compared to placebo for all three-dose ranges and for most outcome measures including: tender joint counts, pain, physician´s global assessment and ESR. The standardised weighted mean differences between treatment and placebo in moderate doses were -0.51 (95% CI -0.88 to -0.14) for tender joint counts, -0.546 (95% CI -0.87 to -0.26) for pain and -0.97 (95% CI -1.25 to -0.70) for global assessment.