Pulse methylprednisolone therapy has been used for the treatment of rheumatoid arthritis. The recent literature describing pulse therapy for this disorder is reviewed. The effects of pulse steroids on the immune system, potential side effects of therapy, and recommendations for its use are presented. Because of the lack of substantial benefit and the possibility of adverse side effects, pulse methylprednisolone therapy should be considered investigational for short-term use in patients with aggressive rheumatoid arthritis undergoing induction therapy with long-term agents such as gold or penicillamine. More study is indicated before generalized use of this modality can be advocated.