IMMUNOMODULATING THERAPY OF SYSTEMIC JUVE NILE RHEUMATOID-ARTHRITIS -USE OF HIGH-DOSE INTRAVENOUS GAMMA-GLOBULIN

Two children of 9 and 10 years suffering from severe systemic juvenile rheumatoid arthritis were treated intravenously with high-dose human immunoglobulin. Treatment was performed every 4 weeks for 7 and 18 mon ths, respectively. Improvement of arthritic symptoms was demonstrable by significant decreases of Ritchie index and number of swollen joints and the disappearence of heated joints in one patient. The other pati ent was free of arthritic symptoms since the introduction of immunoglo bulin therapy. Clinical symptoms of systemic illness were markedly imp roved and no relapse was seen. Laboratory parameters also improved, in cluding erythrocyte sedimentation rate, C-reactive protein, hemoglobin , and serum iron levels. Parallel investigations of immunological para meters revealed a decrease of serum Il-1beta and Il-6 levels and a dim inished in vitro production of Il-1beta, Il-6, and tumor necrosis fact or-alpha. Therefore, we suggest a decreased activation status of the m onocyte-macrophage system as one possible mode of action.