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The treatment of rheumatoid arthritis and psoriatic arthritis with cyclosporin A is described. Cyslosporin A is a new selective immunosuppressant which acts primarily on the T lymphocytes. It has already been shown to be effective in preventing rejection following kidney transplantation as well as in preventing graft-versus-host disease. In rheumatoid and psoriatic arthritis, however, its effect was not satisfactory, although rather different in the two conditions; overall only about one third of the patients showed any marked improvement. By contrast, and for reasons which are as yet unexplained, it had a beneficial effect on the cutaneous symptoms of psoriasis. Cyclosporin A had little effect on immune parameters. Side effects--mainly kidney toxicity, gastro-intestinal reactions and hirsutism--were common but reversible. On present evidence its principal indication among rheumatological diseases would seem to be as a treatment for severe, intractable psoriatic arthritis.
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