Optimum therapy of systemic lupus as well as the other autoimmune rheumatic diseases should be based upon pathogenetic considerations. We present an hypothesis as well as supporting data that the B-cell repertoires of individuals with both murine and human lupus initially are relatively normal. Even though there is increased antibody production, it is increased proportionally for many specificities. Later, more selective increases lead to selective representation of certain specificities characteristic of that individual. Therapy during the polyclonal phase is most likely to be effective in bringing about a sustained remission. Such therapy should be directed at preventing or interfering with the polyclonal activation. Later in disease, after particular immune responses become relatively augmented and possibly fixed, it may be necessary also to interfere directly with the specific augmented responses, especially those which are found to be inducing disease. Whereas SLE is an antibody-mediated disease with decreased DTH, other autoimmune diseases are mediated less by antibody and more by DTH. As a result, therapies for those diseases, especially those directed at the DTH, should be based upon principles other than those for SLE. More-over, there is a greater likelihood in the other diseases of antigen-specific therapy and even vaccination for prevention.
ASJC Scopus subject areas
- Immunology and Allergy