Summary
The value of intravenous bolus therapy was investigated in patients with severe active rheumatoid arthritis. Nitrogen mustard was given in 3 intravenous bolus injections (0.1mg/kg body weight) over 3–5 weeks. In a controlled study of 11 patients the actively treated ones (7 cases) showed greater improvement in all the clinical and laboratory variables measured than did the controls (4 cases). A prospective evaluation of this treatment in 22 patients over 6–18 months showed it had a persistent effect and was associated with clinically significant improvements in the assessments of disease activity. We consider bolus therapy with intravenous nitrogen mustard to be of value, but its use should be restricted to patients with severe rheumatoid arthritis during hospital admission, and it should be combined with other therapy.
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Gerber, N.L., Steinberg, A.D. Clinical use of immunosuppressive drugs. Drugs 1976, 11, 14–35.
Liebling, M.R., Lieb, E., Mclaughlin, K., Blocka, K., Furst, D.E., Nyman, K., Paulus, H.E. Pulse methylprednisolone in rheumatoid arthritis: a double-blind cross-over trial. Ann. Intern. Med. 1981, 94, 21–26.
Hess, E.V., Kammen, P.L. Pulse therapy in rheumatoid arthritis Ann. Intern. Med. 1981, 94, 128–129.
Kotzin, B.L., Stober, S., Engelman, E.G., Calin, A., Hoppe, R.T., Kansas, G.S., Terrell, C.P., Kaplan, H.S. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation. N. Engl. J. Med. 1981, 305, 969–975.
Trentham, D.E., Belli, J.A., Anderson, R.J., Buckley, J.A., Goetzl, E.J., David, J.R., Ausken, K.F. Clinical and immunological effects of fractional total lymphoid irradiation in refractory rheumatoid arthritis. N. Engl. J. Med. 1981, 305, 976–981.
Scott, D.G.I., Bacon, P.A., Allen, C., Elson, C.J., Wallington, T. IgG rheumtoid factor, complement and immune complexes in rheumatoid synovitis and vasculitis; comparative and serial studies during cytotoxic therapy. Clin. Exp. Immunol. 1981, 43, 54–63.
Jimenez Diaz, C. Treatment of dysreaction diseases with nitrogen mustards. Ann. Rheum. Dis. 1951, 10, 144–152.
Jimenez Diaz, C., Merchante, A., Perianes, J., Lopez Garcia, E., Puig Leal, J. Treatment of disease of dysreaction with nitrogen mustard. I. Rheumatoid arthritis. Rev. Clin. Esp. 1950, 38, 261–272.
Popert, A.J. Chloroquine: a review. Rheumatol Rehabil. 1976, 15, 235–238.
Steinbroker, O., Traeger, C.H., Batterman, R.C. Therapeutic criteria in rheumatoid arthritis. J.A.M.A. 1949, 140, 659–662.
Hodges, P.W., Bean, R.E., Routh, W.B., Daum, K. Effects of nitrogen mustard therapy in patients with rheumatoid arthritis. Arch. Phys. Med. 1954, 35, 371–376.
Robecchi, A., Cartesegna, F., Danco, V. Observations on 69 cases of rheumatoid arthritis treated with Di-(2-chloroethyl)-methylamines hydrochloride. Rev.Rhum. Mal Osteoartic. 1954, 21, 823–826.
Losada, M., Etcheverry, L.R., Daiber, A., Guzman, C. Experience with nitrogen mustard in the treatment of rheumatoid arthritis. Rev. Med. Chil. 1952, 80, 164–168.
Retboll, G., Egemose, T., Hosti, J.E. Treatment of polyarthritis chronica with nitrogen mustard (Erassi). Acta. Med. Scand. 1955, 151, 289–294.
Segal, A.M., Couri, J.M., Clough, J.D., Krakauer, R.S. Treatment of the acute flare of rheumatoid arthritis; intravenous nitrogen mustard versus intravenous methylprednisolone pulse. Revue Rheum. Mal. Osteoartic. (XVth International Congress of Rheumatology) 1981, Abstract 130.
Layle, J.K. Lymphoid irradiation for rheumatoid arthritis. N. Eng. J. Med. 1982, 306, 487.
Jones, J.G., Lewis, P., Hazleman, B.L. The treatment of persistent synovitis with nitrogen mustard. Rheumatol. Rehab. 1980, 19, 154–160.
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Kitt, R., Scott, D.L., Coulton, B.L. et al. Nitrogen mustard in severe rheumatoid arthritis. Clin Rheumatol 2, 27–35 (1983). https://doi.org/10.1007/BF02032065
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DOI: https://doi.org/10.1007/BF02032065