Because agammaglobulinemic patients show a markedly increased incidence of a rheumatoid-like arthritis, which improves after y globulin treatment, the clinical and serological changes resulting from repeated injections of pooled human y globulin given to adult patients with rheumatoid arthritis have been evaluated HE OBSERVATION' that 30 per cent of T patients with congenital sex-linked recessive and acquired agammaglobulinemia have a disease clinically indistinguishable from rheumatoid arthritis (RA) suggests that the defective immune response in these patients may in some manner contribute to the pathogenesis of their arthritis. Good and Gabrielsen4 gave repeated injections of pooled human gamma globulin ( HGG ) to agammaglobulinemic subjects with arthritis, and observed improvement in synovitis, in manifestations of arteritis, and even the disappearance of subcutaneous nodules. These observations raise the possibility that an infectious agent causing in a controlled, double-blind study. No significant beneficial effects on laboratory or clinical parameters were observed. ' However, 2 of the 10 patients treated developed precipitating anh%ody to a P globulin component of the globulin preparation given.
the arthritis was neutralized in such patients by antibodies contained in the pooled HGG with which they were treated. By analogy, classical RA may be associated with an inapparent defect in the immune response to an infectious agent capable of being neutralized by passively administered antibody. This possibility has been evaluated in a controlled, double-blind study in which patients with RA received repeated injections of HGG over a 15 week period.
Methods
Twenty-one patients with active RA, each satisfying the American Rheumatism Association criteria5 for definite or classical disease, were assigned to two treatment groups by random draw-