Rheumatology 2001;40:1192 Anti-thymocyte globulin in scleroderma

SIR, The detailed study of aggressive immunosuppressive treatment of scleroderma by Stratton et al. [1] is of great interest. Certainly novel approaches are justified in a rheumatic disease which has proved resistant to all forms of treatment. Indeed my colleagues and I instituted a similar trial of anti-thymocyte in combination with other immunosuppressive drugs which was reported in a conference proceedings [2]. However, the initial improvement was not sustained in a longer follow-up than the original mean of 3.7 yr. We also encountered a high incidence of serum sickness induced by anti-thymocyte globulin and one patient (not included in the report) died from an acute renal crisis during the initial period of steroid treatment. Perhaps the most interesting outcome of such trials is the poor response of scleroderma to intensive immunosuppression compared with other ‘autoimmune’ rheumatic diseases, thereby raising questions about current concepts of immune mechanisms in scleroderma.