Unsuccessful treatment with fludarabine in four cases of refractory rheumatoid arthritis

The aim of this study was to evaluate the efficacy of fludarabine treatment in patients suffering from refractory rheumatoid arthritis. Four patients affected by refractory seropositive rheumatoid arthritis underwent treatmen t with fludarabine for 6 months. The drug was administered intravenously at a dose of 25 mg the first month in a single infusion, and then monthly for 5 months at a dose of 25 mg for 3 consecutive days. All four patients obta ined no clinical benefit from the treatment; moreover, inflammation indices worsened and the prednisone dosage was increased during the trial, in spit e of a significant fall in CD4+ T cells. In our experience low-dose fludara bine is not useful in the treatment of refractory rheumatoid arthritis.