Abstract

While conventional state-of-the-art immunosuppression can lead to significant improvement for patients suffering from rheumatic diseases, only in rare cases a therapy-free remission is achieved. In most cases stopping of treatment results in disease relapse. Apparently, components of the immune system are refractory to conventional immunosuppression and can drive the inflammation. Experimental and clinical evidence suggests that cells of the immunological memory persist despite immunosuppression and if pathogenic play a major role in the chronification of the disease. In particular long-lived memory plasma cells secreting autoantibodies represent a major therapeutic challenge. Once generated, they are not subject to physiological and even conventional therapeutic immune regulation. Their elimination may be prerequisite to curative therapies. A detailed understanding the lifestyle of long-lived memory plasma cells will be important to address this cell type therapeutically.