Abstract
To evaluate the merits of introducing plasma exchange for the treatment of collagen diseases and to assess the usefulness of this therapy, a retrospective study of 19 patients with collagen disease, consisting of eight rheumatoid arthritis (RA), three malignant rheumatoid arthritis (MRA), and eight systemic lupus erythematosus (SLE) patients, was undertaken to determine serological changes after this therapy and correlate the level of improvement in their clinical symptoms.
All eight RA patients underwent double filtration plasmapheresis (DFPP) therapy and four of these patients concomitantly received immunoadsorption (IA) therapy. All three MRA patients also received DFPP therapy, and two received IA therapy in parallel. The eight SLE patients included one who was receiving total plasma exchange (T. PE) therapy, whereas the remaining seven were given DFPP treatment, with three of this number simultaneously received IA therapy.
The reason for introducing plasma exchange therapy for the RA and MRA patients was that they had developed polyarthritic pains and manifested progressive renal disorders that were becoming increasingly resistant to palliative, preservative therapy; in the case of the SLE patients, this therapy was introduced because they too were manifesting progressive renal disorders that were becoming increasingly resistant to palliative, preservative therapy and one of them was presenting with complications of the nervous system. Thus, this therapy had been administered in the hope of achieving some improvement in these patients.
All of the RA and MRA patients, 11 in total, responded well to plasma exchange therapy, which resulted in either the alleviation or disappearance of their arthritic pains. However, in only five (45.6%) of these 11 patients was it possible to correlate the improvement in their arthritic symptoms with a post-therapeutic reduction in their blood RAHA level. As for the three MRA patients, one showed an improvement in renal function. With regard to the six SLE patients, five showed an improvement in renal function. Also, in six (75.0%) of these eight SLE patients, it was possible to correlate the extent of improvement in their clinical symptoms with a reduction in the anti-nuclear antibody and the anti-DNA antibody levels in their blood.
Based on these findings, the long-term prognosis of RA and MRA patients given this plasma exchange therapy appears encouraging, but regular maintenance therapy is required. For SLE patients, the long-term prognosis is even more favorable, with possible recovery after short-term treatment. Thus, these findings reflect the effectiveness of plasma exchange therapy.
It thus appears that for collagen disease cases that become resistant to palliative, preservative therapy, radical treatment in the form of plasma exchange therapy is definitely effective.
