HIGH-DOSE INTRAVENOUS IMMUNOGLOBULIN THERAPY FOR RHEUMATIC DISEASES -CLINICAL RELEVANCE AND PERSONAL-EXPERIENCE

The actual efficacy and applicability of high dose intravenous immunog lobulin (IVIG) therapy in the rheumatic disorders is still being debat ed. In the last few years clinical results have become available on a large number of patients, and efforts have been devoted to experimenta l studies of the mechanism of action of IVIG. However, the results of controlled clinical trials will be crucial to indicate stricter guidel ines and directions for future clinical and experimental research. IVI G is of major value in Kawasaki disease and in severe lupus-associated thrombocytopenia. Its possible benefits are also remarkable in refrac tory dermatomyositis and probably in some patients with the antiphosph olipid syndrome and recurrent miscarriages despite standard treatment. At present, the role of IVIG therapy remains controversial in lupus n ephritis and in systemic vasculitis, while it does not seem to be effe ctive in rheumatoid arthritis.