Abstract • We have developed a system of extracorporeal circulation that removes proteins of the molecular weight of the circulating immune complexes of rheumatoid arthritis by cryogelation with hollow-fiber membrane filtration. A 52-year-old woman with a 36-year history of severe, unremitting, high-titer, seropositive rheumatoid arthritis who had failed to respond to anti-inflammatory, antirheumatic, and cytotoxic drugs was chosen for a trial of this system. A rapid and sustained decrease in circulating immune complexes as measured by C1q binding occurred, accompanied by a much slower improvement in clinical factors of disease activity. Rheumatoid factor changed very little and loss of other serum proteins by the procedure was relatively modest. This new procedure was successful in removing circulating immune complexes in a patient with rheumatoid arthritis, and in inducing a remission in one who has not had such in 36 years, while sparing volume and other plasma proteins. (Arch Intern Med 1982;142:395-397) References 1. Burnett EV: Circulating immune complexes: Their immunochemistry, detection, and importance. Ann Intern Med 1979;91:430-440. 2. Calabrese LH, Clough JD, Krakauer RS, et al: Plasmapheresis therapy of immunologic disease: Report of nine cases and review of the literature. Cleve Clin Q 1980;47:53-72. 3. The Role of Immune Complexes in Disease , World Health Organization Technical Report, series 606. Geneva, 1970, pp 1-58. 4. Goldman JA, Casey HL, McIlwain H, et al: Limited plasmapheresis in rheumatoid arthritis with vasculitis. Arthritis Rheum 1979;22:1146-1150.Crossref 5. Wallace DJ, Goldfinger D, Gatti R, et al: Plasmapheresis and lymphoplasmapheresis in the management of rheumatoid arthritis. Arthritis Rheum 1979;22:703-710.Crossref 6. Adams WS, Blahd WH, Basset SH: A method of human plasmapheresis. Proc Soc Exp Biol Med 1952;80:377-379. 7. McCullough J, Fortuny IE, Kennedy BJ, et al: Rapid plasma exchange with the continuous flow centrifuge. Transfusion 1973;13:94-99.Crossref 8. Powell LC Jr: Intense plasmapheresis in the pregnant Rh-sensitized woman. Am J Obstet Gynecol 1968;101:153-170. 9. Malchesky PS, Asanuma Y, Blumenstein M, et al: The on-line removal of macromolecules by plasma cooling and membrane filtration. Mitt Klin Nephrologie 1981;10:44-53. 10. Zubler RH, Lange G, Lambert PH, et al: Detection of immune complexes in untreated sera by a modified 125I-C1q binding test: Effect of heating on the binding of C1q by immune complexes and application of the test to systemic lupus erythematosus. J Immunol 1976;116:232-235.
Archives of Internal Medicine – American Medical Association
Published: Feb 1, 1982