Intermittent cyclophosphamide in refractory rheumatoid arthritis.

Three patients with refractory rheumatoid arthritis were treated with oral cyclophosphamide; in two cases this was supplemented with pulse treatment with methylprednisolone. Long term remission was induced in all three patients and was sustained until follow up at least nine months after the methylprednisolone was stopped. Leucopenia occurred but resolved when cyclophosphamide was reduced from daily to intermittent dosing. Intermittent treatment with cyclophosphamide, possibly in conjunction with pulses of methylprednisolone, may induce remission in patients with rheumatoid arthritis refractory to other forms of treatment.