Objectives Combined plasmapheresis (PP) with methotrexate was used in 39 children aged 2 – 15 with severe system variant juvenile rheumatoid arthritis. Juvenile rheumatoid arthritis accomponied persistence infection and septic complication.
Methods PP was conducted every other day 5 times. After each PP followed by immunosupressants therapy (PIT) (bolus methylprednisolone, methotrexate). Total dose was at most 15 mg/week. Then patients received injections imunoglobulines every other day 3 times. Total dose imunoglobulines was 0,4 ? 0,6 mg/kg. 12 patients had herpes infection. Before intensive therapy patients received zovirax.
Results During first week by used intensive methods of therapy used to disappear basic indication of disease. After 2 weeks state of patients was stably and not required intensive therapy. 9 patients from 39 had remission about 12 months. These patients used intensive methods of therapy repeatedly. 12 patients had exacerbation a year later after intensive therapy. These patients received only basic therapy. 1 died 2 years after the end of the treatment. 17 patients developed complete remission in 16 ? 36 months. All these patients received basic therapy (prednisolone, methotrexate).