The efficacy of plasmapheresis or leukocytapheresis for articular and extraarticular manifestations of rheumatoid arthritis.

The authors investigated the clinical effectiveness of plasmapheresis (PP) or leukocytapheresis (LP) in 21 patients with articular or extraarticular manifestations of rheumatoid arthritis (RA). Salt-amino acid coprecipitation (SAC) or double membrane filtration plasmapheresis (DFPP) were used as PP regimens, and a centrifugation method (CS-3000) and leukocyte removal filter (Cellsorba) were used as LP regimens. The results were as follows. The removal rate of plasma globulin was higher with SAC than with DFPP, and the removal rate of leukocyte was higher with Cellsorba than with CS-3000. Based on a comparison of the present apheresis methods for short-term therapy, the leukocyte removal regimen proved more effective than the PP regimen by DFPP. In patients with extraarticular manifestations of malignant rheumatoid arthritis (MRA), there were rapid and dramatic intractable skin ulcers, rheumatoid nodules, low serum levels of complements, and high levels of immune complex. Cellsorba was the more useful regimen in short-term apheresis therapy as compared with DFPP. In RA or MRA patients receiving the long-term PP or LP regimen obvious improvements in grasping power and C reactive protein (CRP) levels were observed. The PP or LP regimen continuation rate was 88, 79, and 54% at 3, 12, and 20 months, respectively.