The concept of using hematopoietic stem cell transplantation to treat patients with autoimmune disease was first provided by animal studies and anecdotal case reports. Advances over recent years in autologous hematopoietic stem cell transplantation, most notably cytokine-mobilized peripheral blood stem cells, have been followed by its specific use to treat severe autoimmune and inflammatory diseases. Guidelines have been published, and, by March 1999, 150 cases were registered with the International Autoimmune Disease Stem Cell Project Database. This review summarizes the literature published with respect to inflammatory rheumatic disease over the past few years and discusses future directions aimed at refining this intensive approach.