The recent approval of penicillamine (Cupramine) for use in rheumatoid arthritis has given the physician another remission-inducing drug for this disease. A thorough understanding of penicillamine's administration and toxicity is necessary before the physician begins to use it. Although its efficacy is similar to gold, side effects are considerably more diverse, and longterm side effects require further assessment. This article reviews the clinical use of gold and penicillamine and the factors which may influence the choice of one drug over the other in a given patient.