2,000‐Centigray total lymphoid irradiation for refractory rheumatoid arthritis

Abstract

Because toxicity with the use of 3,000 centiGray (cGy) of total lymphoid irradiation (TLI) was observed in an earlier study, 2,000‐cGy treatments were delivered in a 2‐portal format to 7 patients and in a modified 3‐portal fashion to 6 patients, as part of a randomized, investigator‐blinded trial of TLI treatment for refractory rheumatoid arthritis. Analysis of combined data from the 13 patients revealed statistically significant improvement in 5 clinical indicators of disease activity at the end of TLI and 6 and 12 months later, accompanied by T4‐specific immunosuppression. Management considerations resulted in the introduction of prednisone therapy in 5 patients, methotrexate in 4, and azathioprine in 1 during the interval of 8–12 months post‐TLI. Herpes zoster occurred in 5 patients prior to the initiation of this additional therapy. These data indicate that, in patients with rheumatoid arthritis, a TLI dose of 2,000 cGy is sufficient to produce measurable benefit that lasts for 6 months, and that the improvement can be maintained at 12 months by the use of prednisone and methotrexate.

Lymphoid irradiation in intractable rheumatoid arthritis. Long‐term followup of patients treated with 750 rads or 2,000 rads

“…Corticosteroids were introduced de novo in 2 patients, and treatment with remittive antirheumatic drugs was begun again in 4 patients. These observations are in keeping with those of Tanay et a1 (I@, who reported recrudescence of disease that required the reintroduction of remittive drugs in 8 of 32 patients followed for up to 48 months after therapy with total LI, and those of Trentham et al (19), who had similar findings in 5 of 15 patients followed for up to 12 months following 2,000-rad L1.…”

Herpes Zoster in Breast Cancer Patients after Radiotherapy

“…The highest frequencies of zoster have been described in patients with total body irradiation (TBI) for bone marrow transplant [2]. There are also reports about zoster after 20 Gy TBI for rheumatoid arthritis suggesting that immunosuppression after large field irradiation may be associated with an increased risk of zoster [14]. On the other hand, there are several reports showing no association between radiotherapy and zoster or even a decreased frequency of zoster after prior radiotherapy.…”

“…Radiation may also exert a transient immune depression, especially when large fields are applied. This immunosuppressive effect has been used in the treatment of rheumatoid arthritis and multiple sclerosis [2,14].…”

The role of cytokines in the pathogenesis of rheumatoid arthritis

“…A substantial amount of information, however, suggests that the inflammatory process may be driven by the T4 helperinducer cells infiltrating the synovium [23,86,88,101,131,177,185]. After activation by specific antigen, these T cells produce cytokines and induce the cascade of local and systemic events characteristic of RA.…”