In a six-month study, patients with severe rheumatoid arthritis and only partial responses to methotrexate had clinically important improvement after combination therapy with cyclosporine and methotrexate. Side effects were not substantially increased. Long-term follow-up of patients treated with this combination is needed.

This study supports the use of nonsurgical treatment in patients with DMI. It also demonstrates that DMI can be temporally associated with death.

The progression of rheumatoid arthritis (RA) is documented in a patient receiving a sex‐mismatched, allogeneic bone marrow transplant (BMT) for gold‐induced marrow aplasia. DNA typing confirmed a high probability of a full donor engraftment (complete chimerism). Although the RA was in complete remission 2 years post‐BMT, clinical, laboratory, histologic, and radiologic evidence of the recurrence of synovitis from 3–13 years post‐BMT is presented. Implications of these observations for theories of the pathogenesis of RA and the future of immunotherapies are discussed.

Objective. To compare the relative safety and efficacy of azathioprine (AZA), methotrexate (MTX), and the combination of both in the treatment of active rheumatoid arthritis (RA). Methods. Two hundred twelve patients with active RA were entered into a 24‐week prospective, controlled, double‐blind, multicenter trial and were randomly assigned to 1 of 3 treatment groups. Results. One hundred fifty‐eight patients finished 24 weeks of the study. There were no remissions seen but response rates were greater than 30% for all outcome measures. Combination therapy was not statistically superior to MTX therapy alone, but both combination therapy and MTX alone were superior to AZA alone when patients were analyzed by intent‐to‐treat and with withdrawals treated as therapy failures. If only patients who continued taking the therapy were analyzed, the mean improvement was greater for AZA therapy than for MTX, while the combination remained the most active. Adverse effects on the gastrointestinal tract and elevations of liver enzyme levels were the most frequent causes for discontinuations. Conclusion. Both combination therapy and MTX alone were superior to therapy with AZA alone for active RA but were not statistically different in their effect on outcome assessment.

Forty‐two patients with definite or classic rheumatoid arthritis entered a prospective 24‐week, double‐blind, parallel clinical trial, followed by an 18‐month open phase. All subjects had active synovitis that was unresponsive to nonsteroidal antiinflammatory medications and conventional slow‐acting antirheumatic drugs. Initial treatment with azathioprine (AZA), 100 mg/day, or methotrexate (MTX), 10 mg/week, orally, was adjusted at predefined intervals. Both treatment groups showed statistically significant improvement at week 24, compared with baseline status, in all 9 clinical outcome variables. There were no apparent statistically significant differences in these outcome variables between the 2 treatment groups. There was a trend toward a more marked and rapid improvement in the MTX‐treated group. Radiologic evidence of progression of joint damage was similar in both treatment groups at 24 and 52 weeks. Four of the 42 patients (2 receiving MTX and 2 receiving AZA) discontinued the study because of side effects, and 1 MTX‐treated patient withdrew because of personal reasons. Outcome measures at week 52 (open phase) were not statistically different from those at week 24. Twenty‐three patients were still taking the medication at week 104. We found that AZA and MTX were similarly effective in the treatment of rheumatoid arthritis, and that this beneficial effect was maintained for up to 2 years in most patients.