BONE-MARROW TRANSPLANTATION IN AUTOIMMUNE-DISEASE

Auto-immune diseases such as systemic lupus erythematosus (SLE), scler oderma and rheumatoid arthritis (RA) cause significant morbidity and m ortality (Pincus, 1988; Fessler and Boumpas, 1995) and, although moder n aggressive treatments may suppress disease activity in many cases, f ew if any complete cures for these diseases are reported. Over the las t decade a more aggressive approach to these conditions, with the use of multiple immunosuppressive drugs given at an early stage in the dis ease, have been shown to be beneficial in diseases such as lupus renal disease (Klippel, 1990), but whether this approach significantly impr oves long-term outcome in rheumatoid arthritis is as yet unclear. The use of specific cytokine blockade has heralded a new direction in the management of rheumatoid arthritis and has recently been shown to be s uccessful in the short term (Elliott et al, 1994). Whether this approa ch will sustain remission is yet to be proven. Our relative impotence in terms of management of these conditions demands a re-think of the a etiopathogenesis of these diseases and their treatment.