Thoracic duct drainage in rheumatoid arthritis

Thoracic duct drainage (TDD) led to major improvement of disease in two of five patients with severe rheumatoid arthritis and lesser improvement in two others. This improvement was maintained as long as 10 months, but reassertion of disease activity was seen despite use of azathioprine in standard immunosuppressive doses. A consistent fall in the mitogen-induced proliferative responses of blood lymphocytes occurred during TDD, along with a shift in the ratio of OKT4/T8 to a higher proportion of OKT8. However, there was minimal effect on B cell function and no demonstrable influence on complement activating events in the disease, and there was an inverse relationship between responsiveness to TDD and the degree to which in vivo complement activation was occurring. We suggest that it may be important to assess the candidacy of RA patients for given apheresis procedures by sensitive measures of the degree of activation of complement proteins.