Treatment of patients with refractory rheumatoid arthritis with extracorporeal protein A immunoadsorption columns: a pilot trial.

OBJECTIVE: To evaluate the safety and effectiveness of extracorporeal immunoadsorption with protein A (PROSORBA) columns in the treatment of refractory rheumatoid arthritis (RA). METHODS: Eleven patients with refractory RA were enrolled in an open prospective trial of 24 weeks' duration. Nine patients received 15 treatments over a 12-week period, 1 patient received 15 treatments over a 15-week period, and 1 patient received 12 treatments over a 9-week period. RESULTS: Using the composite criteria of Paulus, et al, 9 patients met the > or = 50% criteria when tested at Week 13, while 4 and 2 patients met the > or = 50% and > or = 20% criteria, respectively, when tested at Week 24. In addition, most of the clinical variables in the 9 responders at Week 13 had significantly improved (p < 0.05); 8 of these responders were able to continue for the entire 24-week study without a change in their arthritic medications, and 2 met the American College of Rheumatology criteria for clinical remission at Weeks 12, and 28 and have remained in remission for 6 and 5 months, respectively. Treatment associated side effects were of short duration and resolved without sequela. Four patients became symptomatically anemic during the treatments. CONCLUSION: Our preliminary study suggests that extracorporeal immunoadsorption therapy with protein A columns was well tolerated and may be effective in the treatment of RA. Further expanded and controlled trials are indicated to explore this new therapeutic modality.

In vitro T lymphocyte proliferative response to Yersinia enterocolitica in Reiter's syndrome. Lack of response in other HLA-B27 positive individuals.

We assessed the in vitro T lymphocyte tritiated thymidine (3HTdr) incorporation response of Reiter's patients in the United States to a serotype 3 strain of Yersinia enterocolitica. The mean 3HTdr incorporation response to the formalin killed form of this strain was 27,409 +/- 5,488 counts per minute for 14 HLA-B27 positive Reiter's patients compared with 5,414 +/- 3,490 cpm for a control group of 11 HLA-B27 positive normal individuals (P less than 0.0005). This high response in Reiter's patients was observed with the formalin killed form of Y enterocolitica serotype 3, but not with a heat killed form or a rough mutant form derived from the same bacterial strain. Further, Y enterocolitica of a different serotype (serotype 8) which is not associated with reactive arthritis failed to induce the high proliferative response observed with the serotype 3 strain. This response indicates that T lymphocytes from spontaneous Reiter's patients are capable of recognizing and proliferating to determinant(s) on the formalin killed form of Y enterocolitica serotype 3. Since this bacterium is associated with Reiter's syndrome in Europe but not the United States, these data are consistent with the possibility that our patients have previously encountered these or similar determinants through unrecognized infection with other microorganisms.