Background Refractory RA – periods of untreatable progression.

Objectives Failure to conventional therapy with DMARD`s including immunosuppressive drugs can be a major problem in patients with refractory RA. We studied especially the clinical efficacy of an additional treatment with immunoadsorption using a protein A column. Totally six patients with rheumatoid factor positive RA according to the criteria of ARA (female, mean age: 45 years (20–65), duration of disease: 4–12 years) were observed in a follow-up of 6 months.

Methods Plasma was separated by a continuous flow cell separator (A S 104, Fresenius) with venous access. Separated plasma passed down columns containing protein A sepharose (Excorim, Lund, Sweden). The application was performed every second day (number of treatments = 65). Two times of patient`s total plasma volume was treated. Beside clinical parameters like morning stiffness, number of swolen and painful joints and pain scale, values of IgG, IgM and IgA, peripheral blood counts, total protein and coagulation parameters were evaluated before and after each procedure.

Results Four patients showed a significant, sustaining improvement in clinical syndroms over five months.

In two cases there was only minimal and transient success. All six patients tolerated the treatment very well. In three patients transfusion of packed red cells, in two patients also substitution of 20% human albumin was necessary in addition to IgG support.

Conclusion Protein A Immunoadsorption can be considered as a method, which sometimes improves the course of refractory RA and overcomes periods of untreatable progression.