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AB0059 Combination of plasmapheresis and intravenous bolus administration of methotrexate and methylprednisolone in refractory rheumatoid arthritis
  1. HA Asseeva,
  2. SK Soloviev,
  3. AS Chiklikchy
  1. Of the Intensive Therapy, Institute of Rheumatology, Moscow, Russia

Abstract

Objectives To evaluate the effect of synchronic program of intensive therapy (SPIT) on patients with refractory RA.

Methods 20 RA patients with systemic manifestations: rheumatoid nodules (65%), lymphadenopathia (45%), fever (35%), livedo vasculitis (10%). 19 patients (95%) demonstrated intorelability of inefficacy of previous basic therapy, 6 (30%) had a corticosteroid dependency. Before the treatment Wilke?s Index activity was 7,06, Index severity was 11,38.6 courses of plasmapheresis synchronised with pulse-therapy of Methylprednisolone (1500 mg) and Methotrexat (240 mg) during 1 month, after that all patients were prescribed Methotrexat in dosage of 20 mg i.m. for 11 months.

Results 4 patients (20%) had a clinico-laboratory remission in a year after beginning of treatment (Wilke,1993). In all group clinico-laboratory improvement was observed in a month and prolonged during the year. In all causes were no systemic manifestations in a month of the treatment. All 20 patients demonstrated the significant decrease of arthralgies, morning stiffness, number of inflamed joints, growth of indices of functional activity. Prednisolone was abolished in 2 patients and daily dosage was decreased in 4 patients/In a 6 months 16 patients (80%) had a low clinico- laboratory activity. Side effects were minimal and were arrested without additional treatment.

Conclusion Synchronic program of intensive therapy can be considered the effective method of RA therapy enabling to achieve speedy clinical improvement, espessially during severe variants of the disease progressing with systemic manifestations, resistance to basic medication, corticosteroid dependency.

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