Current status of gene therapy for rheumatoid arthritis

Despite the high prevalence of the disease, at present little effective pha rmacological treatment of rheumatoid arthritis is available. Novel approach es utilising biological agents have resulted in the development of new anti arthritic and antiinflammatory agents, such as tumour necrosis factor-alpha (TNF alpha)-specific antibodies and interleukin-1 receptor antagonist (IL- 1ra). Local gene therapy not only allows the pharmaceutical use of these bi ologicals, but also allows for continuous drug supply, which is necessary f or chronic diseases like rheumatoid arthritis. We discuss the basics of rheumatoid arthritis therapy, candidate genes and possible gene transfer methods. A current clinical gene therapy trial is fo cusing on the IL-1 system using IL-1ra as a transgene. The transfer system, clinical protocol and preliminary results are described. After treatment o f 11 patients we feel that gene therapy will offer potential as a new avenu e to treat rheumatoid arthritis.