An interesting paper was published recently in theAnnals of the Rheumatic Diseases examining the effect of intra-articular administration of primatised anti-CD4 antibody in the knee joints of patients with rheumatoid arthritis and persistent synovitis, unresponsive to treatment.1The paper correctly detailed the disappointing results obtained in clinical trials with parenteral treatment with anti-CD4 antibodies, particularly in view of the supposed pivotal role of CD4 positive T cells in the chronic synovial inflammatory response.

The paper showed an apparent improvement in the knee synovitis in patients treated with a low (three patients) and high (seven patients) dose of intra-articular anti-CD4 antibody and no response in two patients treated with placebo, using a combination of magnetic resonance imaging, arthroscopic scoring of the synovitis, and immunohistochemical labelling of the synovial biopsy specimens.

An obvious omission from this paper was any doctor or patient derived clinical parameters to allow the reader to assess the benefit, if any, of this treatment for the patient. The only indication of the clinical efficacy of this treatment in the paper was the statement that two of the patients receiving low …