A short history of anti-rheumatic therapy VIII. The immunosuppressants

If pathological anatomy very much center stage during the nineteenth century, with bacteriology gaining greater attention in the second half of that century, it was immunology, perhaps together with endocrinology, which most left its mark on the twentieth century. Although it had been conceived as a specialization in the last decades of the previous century, it is in the twentieth century, and above all from the 1950s onwards, that research in immunology has seen an expansion without precedent in the study of disease and therapies. It was obvious that this research would involve rheumatology and we could even say that this is the branch of medicine which has been most influenced by the advances in immunology. In fact, the interpretation of rheumatic diseases as being “allergic” was first proposed by Fritz Klinge (1), while the 1940s saw two discoveries which opened the way for immunological diagnosis of rheumatic diseases: that of the rheumatoid factor (2, 3) and that of the LE phenomenon (4). Immunoactive therapy had, however, already been started some time before, even though in the beginning it was used to respond to infection and, therefore, to boost the immune response and not suppress it. The anti-smallpox vaccine, introduced by Edward Jenner in 1796 and the anti-diptheria serum, introduced by Emil Adolf von Behring in 1892, can be considered two of the greatest achievements in medicine. (6) It was only in the 1940s the study began of drugs capable orf depressing or suppressing the immune response. However, even in this case these drugs, at least in the beginning, were not intended so much