Autoimmune diseases

The past two to three years have seen rapid developments in the use of biological therapies to treat the major autoimmune rheumatic diseases. In this review we will focus on the rapid accumulation of data encouraging this approach. Randomized controlled trials using the three tumour necrosis factor (TNF)α inhibitors on the market (infliximab, etanercept and adalimumab) have confirmed, not only the clinical efficacy of TNFα blockade, but also its benefit on radiographic progression of joint erosion in patients with rheumatoid arthritis (RA) and psoriatic arthritis, and on spinal inflammation in patients with ankylosing spondylitis (as measured by magnetic resonance imaging). The impact of anti-TNFα blockade on survival of patients is an important ongoing topic. Some critical, still unresolved, questions about the use of anti-TNFα agents have emerged. Finally, the current role of B cell depletion with rituximab for the treatment of patients with systemic lupus erythematosus is also analysed.