Selective in vivo removal of rheumatoid factor by an extracorporeal treatment device in rheumatoid arthritis patients

Abstract

A prospective phase II trial was conducted to assess the feasibility, tolerance, and efficacy of a device designed for selective removal of rheumatoid factor from the plasma of rheumatoid arthritis patients. The device contained terpolymer hydrogel-coated plates with chemically attached, aggregated human immunoglobulin G, and it operated as an immunoaffinity column. Sixty-one patients aged 25 to 73 underwent weekly plasmapheresis treatments (the primary therapy phase). During the trial, patients continued current rheumatoid arthritis medications without dose adjustments. All patients received two to six treatments (primary therapy). Responding patients were eligible to continue apheresis treatment every 2 to 6 weeks (maintenance therapy). No serious, untoward side effects were noted in the course of this study; of 640 treatments, only 2 (in different patients) were aborted, one because of complaints of dizziness and angioedema and the other because of chest tightness and shortness of breath. Except for a significant (p less than 0.05) decrease in serum iron, no significant changes in complete blood count, serum electrolytes, renal and hepatic function tests, or serum C3 and C4 were noted. Although the trial was not designed to determine clinical efficacy, patients noted less morning stiffness, longer time to onset of fatigue, and improved global pain assessment (p less than 0.004); significant objective improvements were noted in joint pain, tenderness, swelling, and the number of affected joints (p less than 0.001). One-half of the treated patients had at least a 50 percent improvement in objective measures of antirheumatic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Developments in the apheresis procedure for the treatment of inflammatory bowel disease

“…This technology has evolved from whole blood exchange to nonselective plasmapheresis to selective plasmapheresis 1. Selective plasmapheresis has been used to remove specific predefined plasma components, including the pathogens implicated in rheumatoid arthritis 2…”

“…1 Selective plasmapheresis has been used to remove specific predefined plasma components, including the pathogens implicated in rheumatoid arthritis. 2 Apheresis also has been evaluated in inflammatory bowel disease (IBD). Although the exact etiology of IBD remains unknown, it is generally accepted that the final pathway of tissue damage is mediated by the immune response of intestinal mucosal cells via white blood cells (WBCs).…”

Synchronic Intensive Program Therapy of Patients With Rheumatoid Arthritis

“…Ревматоидный артрит (РА) -системное воспалительное заболевание соединительной ткани, поражающее около 1% популяции [21], гетерогенен как по своему течению, так и по от вету на антиревматическую терапию. Проблема лечения этого заболевания остается очень слож ной.…”

“…Даже самые современные терапевтические программы, включая применение антицитоки-Адрес для переписки: Соловьев Сергей Константинович 115522, Москва, Каширское шоссе, 34а Институт ревматологии РАМН, тел. 114- новых антител и комбинированной терапию эф фективны не более чем у 50-70% пациентов [21]. Эффект лечения как правило не стоек, а ремис сия достигается менее чем у 10% пациентов с се ропозитивным РА [21].…”

“…114- новых антител и комбинированной терапию эф фективны не более чем у 50-70% пациентов [21]. Эффект лечения как правило не стоек, а ремис сия достигается менее чем у 10% пациентов с се ропозитивным РА [21]. Вследствие этого одной из актуальных проблем ревматологии остается разработка новых способов лечения РА, особен но у больных с высокой клинико-лабораторной активностью, когда требуется быстрое подавле ние воспалительного процесса, при про грессировании эрозивных изменений суставов и резистентности к проводимому лечению.…”