New therapies for the rheumatic diseases.

: The investigational therapies of the rheumatic diseases reviewed in this issue are at various stages of clinical development. Methotrexate and sulfasalazine represent examples of chemotherapies in which the short-term efficacy and toxicities, at least in rheumatoid arthritis, have been carefully documented by controlled trials. The limited information available on cyclosporin A, combination chemotherapy, and radiotherapy is encouraging and appears to warrant additional, more extensive studies. In particular, randomized trials to determine the effects of these interventions on relevant long-term outcomes such as functional disability, organ failure, and life expectancy are necessary. Careful attention to the adverse consequences associated with these interventions, a limiting factor in many currently available therapies, will be mandatory. Disease modification by biologic agents holds the promise of ushering in an entirely new, more selective approach to therapy. A number of these biologic agents are currently at the threshold of clinical evaluation. In all likelihood, the scientific knowledge of pathogenic mechanisms operative in the rheumatic diseases gained through the use of these agents will be of equal importance to the therapeutic benefits.