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Is there a future for extracorporeal photochemotherapy in the treatment of the rheumatological diseases?
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Introduction |
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The list of so called `disease modifying agents' in rheumatoid arthritis now includes methotrexate and cyclosporin A. The efficacy of certain speculative treatments in the rheumatic diseases including antibody based therapies such as anti-tumour necrosis factor1 and anti-ICAM,2 cytokine toxic fusion proteins,3 oral administration of antigens,4 stem cell therapy,5 and cytokine receptor antagonists6 are being investigated. After the reported success of extracorporeal photochemotherapy (ECP) in systemically disseminated cutaneous T cell lymphoma7 in 1987 its benefits are also being explored in rheumatological conditions.
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Technique of ECP |
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Two hours after oral methoxypsoralen, blood is removed from the
patient, exposed to ultraviolet A light at room temperature, and then
reinfused. This procedure can either be done as a continuous flow or by
concentrating the lymphocytes and reinfusing as a bolus, and is usually
performed on two consecutive days each month. In the initial group of
37 patients with therapy resistant cutaneous T cell lymphoma 27 improved with ECP, and over
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Immunology (including allergy)
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Physiotherapy
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