Though cyclophosphamide is generally used in extremely severe cases of RA, it does not belong to the DMARD class. Some previous studies have classified the drug under DMARDs, but recent publications have not included it (Chakravarty K et al. 2008). The 2000 Cochrane review has concluded that the effect of cyclophosphamide on the RA disease activity is clinically and statistically significant, and it is comparable to that of some DMARDs such as antimalarials or SSZ, but lower than MTX. However, severe drug-related toxicity limits its clinical use (Suarez-Almazor ME 2000). But it is used for managing RA- associated ILD, vasculitis, and neuropathy (Charlie S and Kristin BH 2004).

REFERENCES

1. ChakravartyK, McDonald H, Pullar T, Taggart A, Chalmers R, Oliver S, Mooney J, Somerville M, Bosworth A and Kennedy T. BSR/BHPR guideline for disease- modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of  Rheumatology. 2008; 1-16.
2. Suarez-AlmazorME, Belseck E, Shea B, Wells G, Tugwell  Cyclophosphamide for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2000;(4):CD001157.
3. CharlieS, Kristin  Interstitial lung disease in the patient who has connectivetissue disease. Clin Chest Med. 2004;25:549–559.