Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease caused by abundant inflammatory cytokines produced by lymphocytes, macrophages and fibroblast-like synoviocytes. RA presents many extraarticular manifestations like interstitial pneumonia (IP), amyloidosis, rheumatoid nodules and vasculitis. We are often confronted with difficulties in therapy for drug-resitance RA, drug-allergy RA and RA patients with complications such as IP or renal failure. Currently, over 3500 RA patients have received a treatment called leukocytapheresis (LCAP) in Japan. LCAP is considered a safe and effective therapy, but reports for LCAP are limited. To determine the efficacy and safety of LCAP for refractory RA, drug-resistance RA and malignant RA (MRA), we performed LCAP to 13 RA patients once a week for five weeks, and measured the effectiveness. At the point of 4 weeks after the last LCAP, ACR20 and ACR50 were 30.1% and 7.7%, respectively and the mean of ACR-N was 16.9%. One patient with neuropathy and reticular erythema completely recovered through LCAP. These symptoms did not relapse at 12 months post LCAP. Another patient having undergone hemodialysis (HD) was safely treated with LCAP following regular HD. Five patients with IP also received LCAP safely, although improvement of IP was not found. Adverse reaction to LCAP was limited to nausea and no severe side effects were found. LCAP is a safe and effective therapy for refractory RA, drug-resistance RA and MRA.
