Cyclophosphamide has been used in the therapy of rheumatoid arthritis (RA) for nearly fifty years. An experience gathered throughout that time helped to identify indications, profits, restrictions and side effects related to its use. As a result of the progress in RA therapy in the recent years, including introduction of anti - TNF alpha therapy, the importance of cyclophosphamide significantly decreased. However, despite all restrictions related to its use, there are still RA patients for whom cyclophosphamide can be considered as a first choice drug. In this article we review the current knowledge on the issue.