Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

✍ Scribed by Elizabeth H. Field; Samuel Strober; Richard T. Hoppe; Andrei Calin; Edgar G. Engleman; Brian L. Kotzin; Amir S. Tanay; H. Jane Calin; Candace P. Terrell; Henry S. Kaplan

• Publisher: John Wiley and Sons
• Year: 1983
• Tongue: English
• Weight: 934 KB
• Volume: 26
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780260801

✦ Synopsis

Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid .