Prospects in the immunological treatments of rheumatoid arthritis.

Different trends in the therapeutic immunomodulation of rheumatoid arthritis (RA) have been developed since a few years. Early treatment and/or combined treatments using 2 or 3 classical remission inducing drugs could improve the clinical results. Diet and especially eicosapentanoic acid could influence the clinical signs of RA. Among the non specific immunodepressive agents, methotrexate is of major interest. Immunodepressive agents partly selective of a lymphocyte subpopulation: cyclosporin A, total lymphoid irradiation, act on CD4 cells. Some experimental immunomodulating drugs are under study: type II interferon, thymic hormones, immunoglobulins of placental origin. The specific immunotherapy of RA is still experimental and only used in animal with very promising results. Anticlass II HLA monoclonal or polyclonal antibodies could be one of the major treatments of autoimmune diseases within a few years. The treatment of RA by anti-idiotype antibodies remains, at this moment, theoretical.