[A case of malignant rheumatoid arthritis with long-term improvement by regular use of cryofiltration plasmapheresis]

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Background:

• Malignant rheumatoid arthritis (MRA) is a severe form of rheumatoid arthritis.
• Standard treatments like steroids and immunosuppressants are often ineffective for MRA.
• Distinguishing MRA from adult-onset Still's disease can be clinically challenging.

Observation:

• A 25-year-old Japanese male presented with joint stiffness, swelling, and pain, initially diagnosed as rheumatoid arthritis.
• High fever and rash on admission complicated the differential diagnosis.
• Skin biopsy revealed vasculitis, confirming the diagnosis of malignant rheumatoid arthritis.

Findings:

• Conventional therapies, including high-dose steroids and immunosuppressants, failed to induce remission.
• Double filtration plasmapheresis (PA) provided temporary relief.
• Cryofiltration PA demonstrated a more beneficial and prolonged therapeutic effect, leading to sustained improvement for approximately six years.

Implications:

• Cryofiltration plasmapheresis may be a valuable therapeutic option for managing malignant rheumatoid arthritis.
• The efficacy of cryofiltration PA appears dependent on treatment interval and plasma volume processed.
• This case highlights the potential of apheresis techniques in refractory autoimmune diseases.