Plasmapheresis in the Management of Acute Systemic Lupus Erythematosus?

Limited plasmapheresis in rheumatoid arthritis with vasculitis

“…If CIC are involved in the pathogenesis of rheumatoid vasculitis, plasmapheresis might rapidly remove the complexes and result in more rapid control of the vasculitis. This has been suggested as the mechanism for the beneficial effect of plasmapheresis in some patients with systemic lupus erythematosus (6,7).…”

“…At present we do not believe that the data on concurrent cytotoxic drug and plasmapheresis therapy are sufficient for us to determine just how effective this combination may be in inhibiting the rise in titer of immune complexes, although it is suggested by the laboratory results found in patients 1 and 2. Plasmapheresis therapy has reduced the level of some types of immune complexes and has resulted in clinical improvement in patients with systemic lupus erythematosus, another disease in which immune complexes are thought to play a role in pathogenesis (6,7). Rheumatoid factor, which is often a component of immune complexes in patients with RA, has been shown to be decreased or eliminated after plasmapheresis (5,16) of the patient.…”

“…Circulating immune complexes (CIC) and cryoglobulins have been correlated with the severity of RA and arteritis in some cases (3,4), and clinical improvement has often occurred when levels of cryoglobulins and CIC were lowered (3,4). Plasmapheresis has been shown to reduce the level of rheumatoid factor in patients with RA (5) and the level of CIC in those with systemic lupus erythematosus (6,7).…”

Extracorporeal Removal of Circulating Immune Complexes: From Non-Selective to Patient-Specific

“…To date the therapeutic option of plasma exchange has been considered in almost every systemic disease. In cases of lupus nephritis, rapidly progressive glomerulonephritis concomitant to a variety of diseases, and also in rheumatoid arthritis, elimination of CIC was considered as the key issue for the effectiveness of plasma exchange [4,[7][8][9][10]. Since substitution fluids are completely free of immune complexes, plasma exchange can be very effective in acute removal of CIC if the processed plasma volumes are large enough.…”

Clinical immunologic studies in systemic lupus erythematosus

“…Several varieties of extracorporeal immune-absorbents or apparati capable of specific removal of immune complexes have been devised (37,38). In addition, several reports of selective or batch removal of complexes using plasmapheresis in patients with active SLE have been proposed (39).…”