Evaluation of filtration leucocytapheresis for use in the treatment of patients with rheumatoid arthritis

Objectives. To evaluate the efficacy of filtration leucocytapheresis (LCP) for rheumatoid arthritis (RA). Methods. LCP was carried out three times, with 1 week separating each sessi on, in 25 drug resistant RA patients. Results. During each session, 96, 98, 61, 84 and 8% of the granulocytes, mo nocytes, lymphocytes, platelets and erythrocytes, respectively, that entere d the LCP filler were removed. The number of granulocytes, monocytes and ly mphocytes in the peripheral blood significantly decreased during each sessi on of LCP. However, there was no significant decrease in the number of circ ulating blood cells during the study period. On average, 110 x 10(8) granul ocytes, 5.23 x 10(8) monocytes, and 20.5 x 10(8) lymphocytes were removed d uring LCP therapy. Assessment of RA before and after LCP showed a substanti al and rapid improvement in the tender joints counts, swollen joint counts, and patient's and physician's assessments. No adverse reactions or complica tions were noted. Erythrocyte sedimentation rate (ESR) and C-reactive prote in (CRP) levels decreased following LCP, although the change in the latter parameter was statistically insignificant. The concentrations of serum albu min, gamma-globulin, IgG, IgM, CH50 and rheumatoid factor titres did not ch ange during or after LCP. Careful analysis indicated that 16 of 25 patients with RA showed greater than or equal to 20% improvement following LCP ther apy. Conclusions. Our results suggest that filtration LCP to remove leucocytes f rom the peripheral blood exerts an immunomodulatory effect in patients with RA.