Therapeutic Apheresis in the Treatment of Rheumatoid Arthritis
日高, 利彦 ,
Toshihiko, Hidaka ,
医療法人社団善仁会市民の森病院膠原病・リウマチセンターInstitute of Rheumatology, Zenjinkai Shimin-no-mori Hospital
日本アフェレシス学会雑誌 = Japanese journal of apheresis
136 , 2015-05-31
We have many procedures of an apheresis therapy for rheumatoid arthritis (RA); plasma exchange, double filtration plasmapheresis, cryofiltration plasmapheresis, immunoadsorption plasmapheresis, granulocytapheresis and leukocytapheresis (LCAP). In this article, we discussed these apheresis therapies, especially LCAP. A simple and practical on-line continuous LCAP system has recently been developed. It is equipped with a direct hemoperfusion column (Cellsorba^[○!R], Asahikasei Medical Co., Ltd.) packed with fine-diameter polyester fibers, which are commonly used to adsorb white blood cells to prevent a graft-versus-host reaction during blood transfusion. Clinical trials revealed that LCAP is a safe and effective therapy for patients with drug-resistant RA or RA complicated with vasculitis. Because the procedure is simple and requires no plasma substitutes and the volume needed for extracorporeal circulation is less than that for plasmapheresis, LCAP might be accepted as an optional therapeutic modality for drug-resistant RA. The mechanism of the efficiency of LCAP on RA is unclear. LCAP may cause a reduction of activated T cells from affected joints, down-regulation of Pgp on helper T cells and restoration of Treg function, and that may modify the abnormal cytokine balance. These findings may explain some of the mechanisms by which the articular symptoms are improved by LCAP.