An international consensus report: the use of cyclosporin A in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a painful and disabling condition that is becoming increasingly widely recognized as associated with early mortality. Since the late 1970s, clinical trials have been conducted in both Europe and North America in order to determine whether oral cyclosporin A (CyA) has a role in the management of RA and, if so, how it might best be used. That experience, plus recent advances in our understanding of the mechanisms of action of CyA and of the pathology of RA, provides the foundation for the following consensus recommendations. It is assumed that physicians experienced both in the management of refractory RA and in the use of CyA will be treating patients outside experimental research protocols. All patients will be informed of the potential risks and benefits of treatment with CyA. Any patient to be started on CyA will have a documented complete past medical history, present history and physical examination.