Giant cell arteritis disease patterns: Comment on the article by Brack et al

✍ Scribed by Alan B. Marks

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 111 KB
• Volume: 42
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/1529-0131(199910)42:10<2258::aid-anr39>3.0.co;2-f

✦ Synopsis

al report that filtration leukocytapheresis represents an advance in the management of rheumatoid arthritis (1). I do not believe this procedure is as advantageous as centrifugal online lymphoplasmapheresis for the following reasons:

1. Filtration leukocytapheresis removed only 1.9 ϫ 10 9 lymphocytes per procedure, while centrifugation techniques remove 5 ϫ 10 9 lymphocytes per procedure (2). 2. Circulating lymphopenia, often persisting 3 months after a course of therapy, follows centrifugal lymphocytapheresis, and this correlates with clinical improvement (3). This was not achieved by Hidaka et al. 3. There is little rationale for removing granulocytes from patients who are receiving immunosuppressive drugs. The Asahi filter cannot selectively remove lymphocytes. 4. Nearly all membranes are biologically active. In our experience, they frequently activate complement or produce subtle hemolysis (4). The authors did not study these phenomena in their patients. 5. Our sham studies and comparative studies have suggested that combining plasmapheresis and lymphocytapheresis is superior to lymphocytapheresis alone. Hidaka et al's discussion does not mention work done in this area (2-6).