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[A case of malignant rheumatoid arthritis with long-term improvement by regular use of cryofiltration plasmapheresis]
O Ushiyama1, M Hiida, H Toyoshima
1Department of Internal Medicine, Saga Medical School.
Abstract:
A Japanese man, 25 years old, suffered from stiffness, swelling, and pain of his joints in May 1983. He was diagnosed as rheumatoid arthritis and was given steroid unsuccessfully. Then, he was admitted to our hospital in February 1984. Because of the presence of high fever and rash on admission, differential diagnosis of RA from adult Stills disease was difficult. However, skin biopsy disclosed apparent vasculitis, leading to the definite diagnosis of malignant RA (MRA). We could not induce any remission by large dose of steroid including pulse therapy, various immuno-suppressants, and anti-rheumatic agents, because of lack of effectiveness and side effects of the drugs. Double filtration plasmapheresis (PA) was performed, but its beneficial effect soon disappeared. On the other hand, cryofiltration PA caused more beneficial and prolonged effect, resulting in improvement. Thereafter, he was successfully followed on regular use of PA for about 6 years. His condition depended on the interval between PA and next PA and on the volume of filtrated plasma. He died of septicemia on March, 1991. We report here the case of MRA with long time improvement by regular use of cryofiltration PA.
Insights
Malignant rheumatoid arthritis (MRA) can be challenging to treat. Cryofiltration plasmapheresis (PA) offered prolonged improvement for a patient with MRA, demonstrating its potential therapeutic value.
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.