Membrane plasmapheresis with cryofiltration in rheumatoid arthritis

Malchesky, Paul S.; Smith, James W.; Kayashima, Kohji; Asanuma, Yoshihiro; Nosé, Yukihiko

doi:10.3949/ccjm.50.1.11

Cited by 7 publications

(2 citation statements)

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“…This technique was initially used on a patient with functional class IV seropositive rheumatoid arthritis after other therapies had failed to achieve any lasting remission [8].…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled trial of cryofiltration in rheumatoid arthritis

Malchesky

Smith

Koo

et al. 1988

J of Clinical Apheresis

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In an open trial of cryofiltration in rheumatoid arthritis at our institution, 19 patients received 464 treatments; the intensive schedule of ten treatments in 5 weeks was completed in 14 of the 19, and excellent to good clinical response was achieved in ten of these. The combined results demonstrated significant reductions in Ritchie index, morning stiffness, and 50-foot-walk time in the intensive treatment period, as well as significant increases in hand grip strengths. In the maintenance treatment period treatment frequency was individually selected and at less frequent intervals. Changes in clinical parameters were notably less. Although significant correlations were observed between the percent change in clinical parameters and the percent change in biochemical and hematological parameters, no consistent pattern was found. The favorable results of this trial and other uncontrolled trials has led to a two-center double-blind controlled trial of cryofiltration in rheumatoid arthritis that is now in progress.

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“…This technique was initially used on a patient with functional class IV seropositive rheumatoid arthritis after other therapies had failed to achieve any lasting remission [8].…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled trial of cryofiltration in rheumatoid arthritis

Malchesky

Smith

Koo

et al. 1988

J of Clinical Apheresis

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“…The first on‐line cryopheresis performed in the United States was with the AP06M filter (Asahi Medical, Tokyo, Japan), which has a pore size of 0.2 μm, using the Cryomax‐360 thermoregulator apparatus (Parker Biomedical, Irvine, CA, U.S.A.) (7,8). However, this filter was originally developed as a primary membrane plasma separator and not as a cryofilter (9). It had problems such as low sieving coefficient for albumin due to quick plugging of the filter that required frequent backwashing or filter changes.…”

Section: Cryoprotein Removalmentioning

confidence: 99%

Current Topics on Cryofiltration Technologies

Siami

Siami²

2001

Therapeutic Apheresis

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In the last 40 years, therapeutic plasmapheresis techniques have been improving considerably. These include cryofiltration technologies providing novel ways of removing large amounts of cryoproteins from plasma. The concept of cryofiltration involves exposure of plasma to below core (37°C) and room temperatures (25°C) without freezing. It was initially used to treat diseases such as cryoglobulinemia with systemic vasculitis, rheumatoid arthritis, systemic lupus erythematosus, and ABO-incompatible transplants. There are 2 basic types of cryofiltration. The first method removes cryoproteins, namely cryoglobulins that precipitate at 4°C. Several filters have been used for this procedure like the AP06M (Asahi Medical, Tokyo, Japan) with a 0.2 m pore size, a 0.65 m 2 surface area, and a cellulose diacetate (CDA) membrane. It has been used in the United States and Japan for treatment of rheumatoid arthritis and cryoglobulinemia. A major disadvantage was frequent filter plugging, which was cumbersome and it is no longer used in the United States. The G3 cryofilter (Gelman Sciences, Ann Arbor, MI, U.S.A.) with a 3 m pore size was tried in vitro but proved inadequate by de-sign. Currently in our institution, the cryoglobulin filter (Pall Medical, Ann Arbor, MI, U.S.A.) is used with a 4.3 m pore size, a 0.135 m 2 surface area, and an acrylic copolymer pleat membrane. We performed over 1,200 procedures in 40 patients in the last 8 years. The second type of cryofiltration removes cryogel, which is an agglutination complex of fibrinogen, fibronectin, fibrin split products, and cold insoluble proteins with a heparin core, at temperatures between 2 and 10°C. The AP06M, the AC1740 (Asahi Medical) with a 0.02 m pore size, a 1.70 m 2 surface area, and a CDA membrane, and the Evaflux-4A (Kuraray Company, Osaka, Japan) with a 0.03 m pore size, a 2 m 2 surface area, and an ethylene vinyl alcohol membrane are used to remove cryogel to treat ABO-incompatible transplants as well as rheumatoid arthritis and other previously mentioned diseases. This article will discuss each cryofiltration treatment modality.

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Apheresis in the treatment of chronic relapsing polyneuropathy

Handelsman

1985

J of Clinical Apheresis

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As a distinct inflammatory demyelinating disease, chronic relapsing polyneuropathy can be extremely debilitating and cause respiratory failure leading to death. The cause of the disorder is unknown, although evidence suggests that immune dysfunction plays some role in its pathogenesis. Conventional treatment using steroids and immunosuppressants has been reported both as effective and ineffective in controlling the course of the disease. The rationale for apheresis, as a nonspecific therapy, is related to the removal and/or dilution of circulating cytotoxic factors, and some patients have achieved dramatic and sometimes prolonged remissions from such treatments. Existing evidence from a large and growing number of case reports suggests that apheresis is a reasonable treatment for patients with severe or life-threatening symptoms which fail to respond to conventional therapy. However, convincing data of its efficacy is lacking and must await the results of appropriate randomized clinical trials.

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Membrane plasmapheresis with cryofiltration in rheumatoid arthritis

Cited by 7 publications

References 0 publications

Uncontrolled trial of cryofiltration in rheumatoid arthritis

Uncontrolled trial of cryofiltration in rheumatoid arthritis

Current Topics on Cryofiltration Technologies

Apheresis in the treatment of chronic relapsing polyneuropathy

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