A controlled trial of phenylbutazone, oxyphenbutazone, and a placebo in the treatment of rheumatoid arthritis.

In the past 10 years phenylbutazone (Butazolidin) has been recognized to be of value in the treatment of many painful musculo-skeletal disorders. Currie (1951, 1952) reported favourably, but after initial enthusiasm, it became evident that many side-effects could result. It is now generally accepted that its pain-relieving properties make it particularly useful in chronic disorders of bones and joints. The fact that up to 25 per cent. of patients given phenylbutazone react adversely to it, led to much research to find a similar substance which would be less toxic. Several derivatives of phenylbutazone were detected in the urine of patients receiving the drug (Bums, Gutman, Yu, Paton, Perel, Steele, and Brodie, 1955a; Bums, Rose, Goodwin, Reichenthal, Homing, and Brodie, 1955b), and two of these have been synthesized. One of these, sulphinpyrazone (Anturan), a potent uricosuric agent, now has a definite place in the treatment of gout, and another, oxyphenbutazone (Tanderil),* which is also a naturally occurring metabolite of phenylbutazone, was the subject of this trial. Hart and Burley (1959), comparing oxyphenbutazone with phenylbutazone, found that the new substance was less liable to produce gastro-intestinal disturbance, but was somewhat less potent therapeutically. Other investigations, notably those of Mason and Cramer (1959), Cardoe (1959), and Graham (1960), reported substantially similar findings. Vaughn, Howell, and Kiem (1959) reported rather superior analgesic effects with oxyphenbutazone and noted only one important side-effect: initial salt and water retention.