Immunomodulators.

A new era is emerging in the therapy of rheumatic disease involving the use of biologically based immunomodulators. Cytokines, such as the interleukins and interferons, are proteins produced by activated lymphoid cells which can now be synthesised by genetic engineering techniques. These agents have already been used to correct "immune deficiencies" in patients with neoplastic and inflammatory disease e.g. gamma-interferon in rheumatoid arthritis (RA). Monoclonal antibodies (mca) targeted against lymphocyte cell surface receptors or against autoantibodies have been successfully applied in human lymphoid malignancies, organ transplantation and in animal models of arthritis. Potential problems in man include the development of allergic reactions to mouse proteins and of antibody resistance. Although in its infancy, immunomodulation represents an exciting approach to the treatment of rheumatic disease.