Leukocytapheresis (LCAP) for the treatment of rheumatoid arthritis on a maintenance hemodialysis patient

A 57-year-old-woman, who was treated with regular maintenance hemodialysis (HD), newly contracted rheumatoid arthritis (RA). Oral predonisolone was effective for alleviating her arthralgia but the RA activity became steroid-dependent. For treatment of poorly controlled synovitis leukocytapheresis (LCAP) showed excellent efficacy in the treatment of her joint pain. No serious adverse effects were observed. Serological markers such as CRP, serum amyloid A, matrix metalloproteinase 3 and peripheral blood lymphocyte count fluctuated with her clinical symptoms. We recommend LCAP as candidate therapy for steroid-dependent patients with RA who are on maintenance HI). ders such as RA and ulcerative colitis [Ayabe 1997, Hidaka 1999a,b, Ueki 2000, Yamaji 2001]. LCAP therapy for immunological disorders aims to alleviate the pathogenesis by removing activated lymphocytes and monocytes/macrophages from the peripheral blood [Yamaji 2002]. Although the precise mechanisms of the therapeutic effects of LCAP remain unclear, previous reports noted that LCAP administration did not augment the risk of infection [Hidaka 1999a,b, Ueki 2000]. We report here a patient on maintenance HD and suffering from active RA which was treated effectively by LCAP.