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

D. J. McCarty and G. F. Carrera

Seventeen patients (15 women, two 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 months (mean +/- SD throughout) (range, five to 60 months). Disease suppression began in 14 patients within three to 16 months (mean, seven months). Five patients achieved complete remission, two had activity in a single joint only, seven had partial disease suppression, and three showed no response. Prednisone dosage was decreased or administration discontinued in nine of ten patients (5.8 +/- 1.2 to 2.7 +/- 3 mg/day). Serial hand roentgenograms showed recortication of erosions in nine patients, with "filling in" of some erosions in three of these. No change was seen in the roentgenograms of five patients, while progressive disease occurred in three instances. Combined therapy with small doses of three 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.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Two is better than one? Combination therapy in rheumatoid arthritis
Choy
Rheumatology (Oxford) 2004;43:1205-1207.
FULL TEXT  

Evidence from clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating a 1983 review
Pincus et al.
Rheumatology (Oxford) 2002;41:1346-1356.
ABSTRACT | FULL TEXT  

What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first two years of disease
McQueen et al.
Ann Rheum Dis 2001;60:859-868.
ABSTRACT | FULL TEXT  

Healing of erosions in rheumatoid arthritis
Sokka and Hannonen
Ann Rheum Dis 2000;59:647-649.
ABSTRACT | FULL TEXT  

The role of anti-malarials in rheumatoid arthritis -- the American experience
Khraishi and Singh
Lupus 1996;5:S41-S44.
ABSTRACT  

The use of antimalarials in combination with other disease modifying agents in rheumatoid arthritis--the French Experience
Kahan and Menkes
Lupus 1996;5:S45-S49.
ABSTRACT  

The use of antimalarials in combination with other disease modifying agents in RA -- the British experience
Duncan and Capell
Lupus 1996;5:S50-S58.
ABSTRACT