Objective. To investigate the effect of an intensified treatment protocol synchronizing plasmapheresis with subsequent pulse cyclophosphamide for severe systemic lupus erythematosus (SLE).Methods. A protocol of plasmapheresis (3 X 60 mllkg) and subsequent high-dose pulse cyclophosphamide (36 mgkg) followed by 6 months of peroral immunosuppression was used to treat 14 patients with severe SLE.Results. Rapid improvement was achieved in all patients. Immunosuppressants, including corticosteroids, were withdrawn at month 6 in 12 patients. Eight patients continued without treatment for a mean observation period of 5.6 years (46-91 months).Conclusion. The results demonstrate that treatment-free clinical remission can be achieved in some patients with severe SLE.

Autologous stem cell transplantation with or without in vitro lymphocyte depletion has been suggested as a new treatment option for severe autoimmune diseases. We describe five patients with autoimmune diseases (CREST syndrome, myasthenia gravis and Hashimoto's thyroiditis, systemic lupus erythematosus, atopic dermatitis, and rheumatoid arthritis) who underwent autologous bone marrow (n = 1) or peripheral blood progenitor cell (n = 4) transplantation with unmanipulated grafts as treatment for the autoimmune disease in one case or as treatment for a malignant disorder with a concomitant autoimmune disorder in four cases. In all patients serological and clinical signs of the autoimmune disease recurred early or persisted. These observations should be regarded as a cautionary note concerning the efficacy of high-dose therapy followed by transplantation of unmanipulated autologous stem cells for treatment of severe autoimmune diseases.

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Background: Vesiculo-bullous diseases are a group of chronic cutaneous disorders characterised by mucocutaneous blistering or erosions as a result of development of autoimmunity. Aims: To understand the pathophysiology of pemphigus vulgaris and the recent concepts of Pulse therapy with different modalities and their various actions on different tissue levels. Results &Conclusion-Pulse therapy can be a boon to stomatologists if understood with clarity and applied with precision. It can definitely create miracles in saving lives and help in the outcome of the prognosis of most of the autoimmune disorders.

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