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Rheumatology 2002; 41: 367-374
© 2002 British Society for Rheumatology

Review

The therapeutic uses of intravenous immunoglobulins in autoimmune rheumatic diseases

D. Pyne, M. Ehrenstein and V. Morris

Centre for Rheumatology, University College London, Arthur Stanley House, 40–50 Tottenham Street, London W1P 9PJ, UK


   Introduction
 
Immunoglobulins (antibodies) are plasma proteins produced by B cells, which are essential in the defence against bacterial and viral infections. Dysregulation of the immune system can lead to the formation of autoantibodies and subsequent autoimmune disease. Therapy with immunoglobulin was first studied in the late 19th century, when Von Behring and Kitasato showed that serum taken from rabbits immune to tetanus toxins could protect non-immune rabbits from infection [1]. However, it was not until the 1960s that the first immunoglobulin preparations suitable for intravenous administration were formulated [2]. Subsequently, intravenous immunoglobulin (IVIG) was introduced as replacement therapy in patients with primary immunodeficiencies [3]. In the early 1980s, Imbach and collegues [4] were the first group to use IVIG in autoimmune disease. They gave patients with autoimmune thrombocytopenic purpura, who had been refractory to all conventional measures, an IVIG preparation as an experimental . . . [Full Text of this Article]


   Preparation of intravenous immunoglobulin
 

   Administration and side-effects of intravenous immunoglobulin
 

   Mechanisms of action
 
Fc-dependent mechanisms
V region-dependent mechanisms

   The evidence
 
Inflammatory myositis
Systemic lupus erythematosus
Antiphospholipid syndrome
Vasculitis
Rheumatoid arthritis and juvenile chronic arthritis

   Future directions
 

   Notes
 

   References
 

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