Nitrogen mustard in severe rheumatoid arthritis.

The value of intravenous bolus therapy was investigated in patients with severe active rheumatoid arthritis. Nitrogen mustard was given in 3 intravenous bolus injections (0.1 mg/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.