To describe microvascular abnormalities by nailfold capillaroscopy in patients with primary Sjögren's syndrome (SS) with or without Raynaud's phenomenon (RP) and those with anticentromere antibodies (ACA).

To investigate the efficacy of a single i.v. dose of clodronate encapsulated within small unilamellar vesicles in suppressing joint inflammation and the histological progression of rat antigen-induced arthritis (AIA).

To evaluate the efficacy of the administration of zidovudine (AZT), an antiretroviral drug, in patients with primary Sjögren's syndrome (SS).

To assess the reliability and validity of the EuroQol (EQ-5D) for osteoarthritis of the knee (OA knee).

The International Consensus Meeting on the Mode of Action of COX-2 Inhibition (ICMMAC) brought together 17 international experts in arthritis, gastroenterology and pharmacology on 5 6 December 1997. The meeting was convened to provide a definition of COX-2 specificity and to consider the clinical relevance of COX-2-specific agents. These compounds are a new class of drugs that specifically inhibit the enzyme COX-2 while having no effect on COX-1 across the whole therapeutic dose range. The objectives of the meeting were to review the currently available data regarding the roles and biology of COX-1 and COX-2, and to foster a consensus definition on COX-2 specificity. At the present time, no guidelines exist for the in vitro and in vivo assessment of COX specificity, and it was felt that consensus discussion might clarify some of these issues. The meeting also reviewed recent clinical data on COX-2-specific inhibitors. The following article reflects discussion at this meeting and provides a consensus definition of COX-2-specific inhibitors.

The benefit:risk ratio of HSCT in autoimmune disease appears to justify the initiation of prospective controlled comparative studies. The comparator arm is open, one possibility being mobilized (Cy 2 or 4 g/m2 + G-CSF), but not transplanted. Inclusion and exclusion criteria for different disease categories need to be standardized, as do outcome measurements. In Europe, the EBMT has established a new working party for autoimmune disease with representatives from all involved groups, including the USA. A similar parallel group is being established in North America. The aim will be consensus and standardization of disease-specific aspects. Standardization of immune reconstitution parameters could prove critical in the understanding of autoimmune mechanisms, with early guidelines being developed and available to interested groups. Data collection is critical, with advanced discussions on common registration forms between the EBMT and the American Bone Marrow Transplantation Registry (ABMTR) already taking place. Common detailed disease-specific clinical data forms are now a top priority, so that data from the two major databases may be compared. All patients fulfilling entry criteria should be registered and followed long term, including those not able to be treated for non-medical reasons, such as insurance. This will provide a prospective 'conventional treatment' control group. Regular and flexible liaison between the data managers of both groups will be encouraged, as with regulatory authorities such as the Food and Drug Administration. The following such meeting was in Basel, 8-10 October 1998.

For patients with systemic lupus erythematosus (SLE) who are at risk of disease-related mortality, we have initiated a protocol of intensive immunosuppression and haematopoietic stem cell support. The first patient enrolled in this study was in the midst of a lupus flare manifest by nephritis and rapidly declining renal function, uncontrolled hypertension, immune-mediated cytopenias, and serositis characterized by a large pericardial effusion and abdominal pain. Antinuclear antibody (ANA), anti-double-stranded (ds) DNA and complement were abnormal. This patient is now more than 1 yr post-stem cell transplant and is taking no immunosuppressive medication. Her serologies are normal, effusions have resolved, blood pressure is normal and renal function is markedly improved. The clinical and serological course of this patient is summarized here.

In adults, autologous stem cell transplantation (ASCT) has been described recently as a possible treatment for severe autoimmune disease refractory to conventional treatment. We report here the four first children with severe forms of juvenile chronic arthritis (JCA) treated with ASCT.