GRANULOCYTE AND MONOCYTE APHERESIS SUPPRESSES SYMPTOMS OF RHEUMATOID-ARTHRITIS - A PILOT-STUDY

To investigate if granulocyte and monocyte apheresis mitigates the sym ptoms of rheumatoid arthritis (RA), and influences production of panmy elocytes (CD15(+) CD16(-) cells) at the bone marrow level, 27 RA patie nts who had elevated granulocyte counts were recruited. The granulocyt e and monocyte apheresis column (G-1 column) is an extracorporeal type device packed with 220 g cellulose acetate beads to which granulocyte s and monocytes specifically adhere. Patients received apheresis of 1 hr duration twice per week, 8 times over a period of 4 weeks. To prepa re CD15(+)CD16(-) cells, iliac bone marrow aspirate was obtained at ba seline and at 2 weeks after completion of the apheresis course. Ex-viv o proliferation of bone marrow low density cells and production of IgM -RF were also investigated. Following granulocyte and monocyte apheres is, there was a suppressed tendency in the number of CD15(+)CD16(-) ce lls in patients with high bone marrow CD15(+)CD16(-) cell counts at ba seline. Clinical assessments 2 weeks after the completion of apheresis therapy showed improvements in swollen joint count (P<0.001), tender joint count (P<0.001) and duration of morning stiffness (P<0.005). The results suggest that granulocytes and monocytes/macrophages have a pa thological role in RA and apheresis treatment to reduce or suppress th ese cells should benefit patients with RA.