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The use of intravenous immunoglobulin in rheumatic diseases.

The efficacy of IVIg for vasculitides other than Kawasaki disease is debatable. The high cost of IVIg is an important concern, especially when it is utilized in a setting of questionable efficacy. In recent years, numerous studies have explored the immunosuppressive properties of high-dose intravenous immunoglobulin (IVIg) therapy. IVIg is clearly effective in Kawasaki disease and idiopathic autoimmune thrombocytopenia.1'2 However, its utility in other diseases is less clear. This edition of Clinical Decision-Making reviews IVIg therapy in a variety of rheumatic autoimmune diseases and provides a case example in which an empiric trial was attempted, but failed.