[Lymphocytapheresis in the treatment of chronic polyarthritis. Effect on clinical and laboratory chemical parameters...

Ten patients with rheumatoid arthritis (RA) were treated by lymphocytapheresis. Only patients with severe disease (Steinbrocker classification III/IV, at least two disease-modifying drugs previously unsuccessful, present treatment insufficient) were selected, concomitant treatment was standardized (NSAID and/or low-dose steroids in a fixed dose, administered constantly for 6 weeks). Using an IBM cell-separator, apheresis was administered three times per week for 2 weeks with continuation only in the case of improvement. Lymphocyte elimination rate was 10(9)-10(10) per apheresis in all cases. Only three patients showed significant clinical improvement (evaluated by the Ritchie Index, grip strength and morning stiffness), little (5 patients) or nor (2 patients) change was registered in the other cases. No side effects occurred during treatment. Standard laboratory parameters (including rheumatoid factor, circulating IC) showed no correlations with the course or success of treatment. Interestingly, all therapy responders showed a markedly depressed lymphocyte proliferative capability (LPC, tested with tetanus toxoid/streptodornase as antigens) compared to the non-responders before apheresis, with complete reversal to normal LPC during treatment. Lymphocytapheresis might be a promising additional treatment in a minority of RA patients characterized by a certain form of lymphocyte dysfunction. Markers to preselect such a subgroup are still to be found.