A double-blind, double-dummy controlled study to compare the clinical efficacy and gastric tolerability of salsalate and piroxicam in the treatment of rheumatoid arthritis was performed. Twenty-three patients were treated with 1.5 g salsalate twice daily and 20 with 20 mg piroxicam (taken after the evening meal) for a period of 4 weeks. Patients were submitted to gastroscopy at the start and end of treatment; only patients who presented a normal baseline gastroscopy were admitted to the trial. At the end of the planned treatment period, a statistically significant improvement of all clinical variables was observed in both treatment groups, the difference between the two drugs not being statistically significant. Seven (37%) patients treated with salsalate complained of tinnitus. The results show that salsalate and piroxicam have equal efficacy in relieving the symptoms of arthritis.