[New immunologic treatment of rheumatoid arthritis]

Rheumatoid arthritis is a heterogeneous disease for which no satisfactory therapy is available. Conventional treatments have nonselective immunological effects. Cyclosporin A ensures partially selective immunotherapy. Recently developed selective immunotherapy methods target CD4+ T-cells and their receptors, antigen-presenting cells including macrophages with surface expression of class II HLA antigens, antigen peptide(s) presented by macrophages, class II HLA antigens or T-cell receptors. T-cell suppression can be achieved using monoclonal antibodies or the still experimental T-cell vaccination. Monoclonal antibodies against activation antigens, including CD4, CD5, CD25 (interleukin 2 receptor), CD52, and adhesion molecules, have been investigated in animal studies and open trials in humans. Monoclonal antibodies directed against class II HLA antigens or antigen-presenting cells have been studied in animals. Peptide immunotherapy has yielded promising results in a variety of animal models. Other immunotherapy methods target cytokines, especially those which promote inflammation. Encouraging preliminary results have been obtained in rheumatoid arthritis patients with interleukin-1 receptor antagonists and monoclonal antibodies against tumor necrosis factor alpha. Problems raised by selective immunotherapy for rheumatoid arthritis and potential indications are discussed.