In a randomized, double blind parallel group comparison the antiphlogistic and analgetic efficacy of high-dosed vitamin E (3 x 400 mg RRR-alpha-Tocopherolacetat/d) versus diclofenac-sodium has been investigated in hospitalized patients with established chronic rheumatoid arthritis. After 3 weeks of treatment the vitamin E group (n = 42) as well as the diclofenac group (n = 43) showed a significant improvement of all assessed clinical parameters. Duration of morning stiffness could be reduced under vitamin E treatment from 90 min to 68 min and under diclofenac treatment from 68 min to 30 min. The joint index according to Richie declined from 56 to 46 (vitamin E) and 49 to 34 (diclofenac). Grip strength increased in the vitamin E group as well as in the diclofenac group. In addition, the degree of pain, assessed by a 10 cm visual analogue scale, reduced significantly under vitamin E as well as under diclofenac. Regarding the therapeutical result both, physicians and patients, considered both drugs to be similarly effective. Especially regarding the risk profile of NSAR in long-term treatment of chronic rheumatoid arthritis intake of high-dosed vitamin E is a possible alternative in the treatment of inflammatory rheumatoid diseases.