Low Dose Ciclosporin (CyA) and Prednisone — a Step in the Direction of Selective Immunosuppression in Rheumatoid Arthritis Refractory to Treatment (6-Month Follow-Up)

In our study 15 patients with severe rheumatoid arthritis refractory to treatment were treated with low dose CyA (max. 5 mg/kg body weight/day) in combination with prednisone (6-month follow-up at end of February 1985). 12 patients exhibited a surprising clinical improvement after an average of 7.5 weeks (6–11 weeks). In 3 patients the result was only partly satisfactory. In the course of the 6 months, we did not observe any serious nephrotoxicity such as has been described in other studies with a dosage of 10 mg/kg/day [18]. We believe that individual adjustment of the dose during the first 90 days is of decisive importance. An improvement was seen in various parameters of the disease, such as morning stiffness, number of swollen joints, etc. Little correlation was seen between the clinical improvement and the humoral and cellular laboratory parameters. All virus titres tested were negative throughout the six months. The increased incidence of side effects in HLA-DR4 positive patients (in 8 of 15 patients) is interesting The slight side effects seem to be dose-dependent and exhibit little correlation with the ciclosporin A levels.