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New therapeutic targets in rheumatoid arthritis.

Gene therapy has the significant advantage of providing targeted and continuous administration of a therapeutic agent within the joint. A number of targets of choice are discussed, including cytokines, metalloproteinase inhibitors and angiogenesis costimulators. Gene transfer can also be used to inhibit intracellular biological cascades (apoptosis, signal transduction, cell differentiation). Preliminary Phase I ex vivo studies have confirmed the feasibility of gene therapy in rheumatoid arthritis. Vectors will have to be improved before in vivo studies are performed.