Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting multiple organs and tissues. Although there is a wide range of therapeutic applications, the coexistence of severe side effects and contraindications outlines the necessity of new therapeutic options in the treatment of severe RA. We report on the case of a 71-year-old patient with successful treatment of a complicated RA with tryptophan immunoadsorption combined with low-dose steroids. Bacterial spondylitis developed in this patient during long-term treatment with infliximab and methotrexate. Weekly immunoadsorption sessions with tryptophan columns resulted in continuous suppression of RA activity over a period of more than 5 months, as indicated by laboratory findings, the disease activity score, and the visual analog scale. This is the first report of successful treatment of a refractory and complicated RA using tryptophan immunoadsorption columns. In conclusion, immunoadsorption is a safe and effective therapeutic alternative, which should be considered to bridge infectious complications in patients with severe RA.

Emerging Concepts on Inhibitors of Indoleamine 2,3-Dioxygenase in Rheumatic Diseases

“…Tryptophan immune-adsorption has been used in autoimmune diseases, including RA [145], as a means of removing circulating immune complexes and autoantibodies by binding to the Fc fraction of immunoglobulins. An RA patient received weekly sessions of tryptophan adsorption after the development of bacterial spondylitis during long-term treatment with TNF-blocking agents and methotrexate [145].…”

“…An RA patient received weekly sessions of tryptophan adsorption after the development of bacterial spondylitis during long-term treatment with TNF-blocking agents and methotrexate [145]. This treatment modality was associated with disease remission and maintenance of the clinical improvement for 16 weeks after therapy initiation.…”