Factor VIII antibodies in rheumatoid arthritis. Effect of cyclophosphamide

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Abstract
Three patients with rheumatoid arthritis had bleeding and bruising and had circulating antibodies specifically directed against factor VIII. This is an unusual but serious complication of rheumatoid arthritis. In 2 of the 3 cases, disappearance of the factor VIII antibody coincided with the oral administration of cyclophosphamide; in the 3rd patient, antibody titers declined several weeks after cyclophosphamide therapy was discontinued. Collected experience involving 11 nonhemophilic patients with factor VIII antibodies indicates that a good response to cyclophosphamide therapy may be expected if the antibody titer is < 10 Bethesda units at the initiation of treatment. While optimum treatment of these patients is not yet established, an initial trial of prednisone is suggested and, if there is no response, then therapy with cyclophosphamide.