A case of chronic rheumatoid arthritis remitted with plasmapheresis

Abstract

Plasmapheresis using cryofiltration (DFP) was performed in a 56-year-old male patient with severe chronic rheumatoid arthritis, who had inferolateral myocardial infarction. At the time of initiation of this treatment, the patient was restricted to bed because of his severe knee and shoulder of joint pain resistant to steroid therapy. Laboratory results revealed high level of C-reactive protein (CRP), rheumatoid factor (RA) and immunoglobulin (IgG, IgA, IgM). Two filters were employed in extracorporeal circuit. The separated plasma at the first filter was cooled in a cooling box at 0∼4°C, then cryoproteins were removed from the separated plasma at the second filter. Thereafter 500∼1000 ml of plasma protein fraction (PPF) and 100 ml of 25% albumin solution were added to the remained plasma. The treated plasma was warmed to physiological temperature, and returned to the patient. The patient at first underwent two DFP per one week and then one DFP per four weeks up to the present. Since joint pain and swelling was markedly improved by DFP, the patient could walk by the end of 8th DFP treatment at 3 months later. Serum β- and γ-globulin decreased, but serum albumin increased during the course of treatment. IgA decreased gradually from 1290 to 250 mg/dl. However, it was of interest that high level of CRP and RA remained unchanged in spite of improvement of subjective symptoms. We conclude that this method has a great effect for the treatment of patients with severe chronic rheumatoid arthritis unresponsive to the conventional methods of therapy. © 1985, Japanese Society of National Medical Services. All rights reserved.