Immunological treatment of rheumatoid arthritis

Till now the therapeutic immunomodulation of rheumatoid arthritis (RA) has been non-specific, using either slow acting drugs which act mainly but not exclusively on macrophages (gold salts) or on T CD4+ cells (D penicillamine), or immunostimulating agents (Levamisole) or immunodepressive drugs which do not affect a specific subpopulation of lymphocytes. Various other therapeutic approaches such as dietic manipulations, steroid pulses and plasmapheresis have been proposed. Methotrexate is a very interesting development in the treatment of RA. However, the results of such treatments on the long term outcome of the disease have been unsatisfactory. Early and associated treatments must be studied. After the interesting experimental results obtained with thoracic duct drainage, a partially specific immunotherapy acting mainly on CD4+ T cells has been developed using cyclosporin A and total lymphoid irradiation. However, a more specific immunotherapy of RA may be considered, using monoclonal or polyclonal anti-HLA class II antibodies or anti-CD4 monoclonal antibodies. Immunomodulating treatments with cytokines or anticytokines, anti-T receptor monoclonal antibodies, anti-idiotypic antibodies, and vaccination with T cell clones or synthetic peptides are possibilities of major interest for the future.