Intractable rheumatoid arthritis. Treatment with combined cyclophosphamide, azathioprine, and hydroxychloroquine

Abstract

Patients (15 women, 2 men) with progressive, erosive seropositive rheumatoid arthritis (RA) refractory to conventional therapy were treated with cyclophosphamide, azathioprine and hydroxychloroquine sulfate for an average of 27 .+-. 19 mo. (.hivin.x .+-. SD throughout) (range, 5-60 mo.). Disease suppression began in 14 patients within 3-16 mo. (mean, 7 mo.). Five patients achieved complete remission, 2 had activity in a single joint only, 7 had partial disease suppression and 3 showed no response. Prednisone dosage was decreased or administration discontinued in 9 of 10 patients (5.8 .+-. 1.2 to 2.7 .+-. 3 mg/day). Serial hand roentgenograms showed recortication of erosions in 9 patients, with filling in of some erosions in 3 of these. No change was seen in the roentgenograms of 5 patients, while progressive disease occurred in 3 instances. Combined therapy with small doses of 3 drugs, each with proved antirheumatic activity when used separately in larger doses, may provide satisfactory long-term disease control in patients with intractable RA. This regimen is experimental. Proof of efficacy requires a controlled study. Until such data are obtained, this drug combination is not recommended for general use.