Patients with RA are at risk of cyclosporin A (CyA) toxicity as they have an increased incidence of underlying renal pathology and because of the probable co-administration of NSAIDs. CyA dose, blood levels, and changes in serum creatinine are linked to the severity of renal biopsy changes in patients with RA and other autoimmune disorders, but only limited data regarding the safety of long-term CyA therapy have been reported. Low-dose CyA (preferably without NSAID co-administration) should be reserved for those patients with a poor prognosis who can be carefully monitored using a combination of renal function studies, CyA blood levels and renal biopsy assessment. Consideration should be given to the development of a management strategy that includes renal biopsy at defined intervals in order to detect the onset of progressive renal damage, and which could potentially allow eligible patients to benefit from long-term CyA therapy.