[Treatment of severe or vasculitis associated forms of rheumatoid arthritis by plasma exchanges (author's transl)]

Five patients with typical seropositive rheumatoid arthritis were treated by plasma exchange. All patients had severe affections resistant to conventional treatment, while in four cases the disease involved extra-articular localizations: rheumatoid nodules (3 cases), polyneuritis (1 case), skin necrosis (1 case). Each patient received between 5 and 10 plasma exchanges over a period of 3 to 4 weeks. No major complications were observed. Immediate results were very good in all cases, as shown by absence of clinical expression of the arthritis, marked regression in extra-articular symptoms, and reduction in erythrocyte sedimentation rate without parallel alterations in rheumatoid factor levels. Improvement lasted for only a few weeks in 3 patients, in one case preceded by an acutely painful episode. In the remaining 2 cases, with associated vasculitis, improvement has been sustained for a period that now exceeds one year. Results are compared with those reported in the published literature, and the mode of action and indications for plasma exchange in rheumatoid arthritis discussed.