[Plasma- and lymphapheresis in autoimmune diseases]

More than 25 years ago, first experiences were made using extracorporeal therapy in systemic rheumatic diseases. Since that time, several studies have documented the effect of plasmapheresis and immunoadsorption in eliminating circulating pathogenic antibodies and immune complexes, but these therapies are still not accepted as general options. This may be due not only to resource intensity, but also to controlled studies failing to confirm any obvious benefit because of inappropriate indication criteria and patient numbers. Today, idiopathic-thrombocytopenic purpura, thrombotic thrombocytopenic purpura and cryoglobulinemia also during the course of systemic rheumatic diseases and Goodpasture syndrome are classical indications for extracorporeal therapy. In other acute situations and in severe organ manifestations they may be helpful in addition to or probably even better in synchronization with immunosuppressive therapy. The new therapeutic options given by immunoadsorbers-a continuous application in acute disease states or chronic use instead of immunosuppressive drugs-have still to be evaluated in systemic rheumatic diseases. The efficacy of leukapheresis has long been proven in rheumatoid arthritis and systemic connective tissue diseases and may be increased by new technical equipment allowing peripheral elimination by specific leukocyte filters. The efficacy of photopheresis in systemic sclerosis and other systemic rheumatic diseases cannot be estimated by the available results. In general, the limited number of patients suitable for the different extracorporeal methods necessitates multicentric cooperation to reconsider definitively the efficacy of these therapeutic options in systemic rheumatic diseases.