High‐dose immunoglobulin therapy as an immunomodulatory treatment of rheumatoid arthritis

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Abstract
Objective. To investigate the efficacy of high‐dose intravenous immunoglobulin (IVIg) in the treatment of refractory rheumatoid arthritis (RA).Methods. Ten patients with active, severe RA that was unresponsive to first‐ and second‐line agents were administered IVIg monthly, for 6 months.Results. Following IVIg treatment, there was significant improvement in both subjective and objective parameters of disease activity in all 9 patients who completed the protocol. This improvement was noted to occur as early as after the second infusion of IVIg. After discontinuation of the treatment, all patients had a relapse of the disease within a few weeks.Conclusion. Since the reduction in clinical activity paralleled a decrease in the CD4+CDw29+: CD4+CD45RA+ cell ratio, some of the therapeutic benefits associated with IVIg may be due to a direct influence on the CD4+CD45RA+ subset. Although the possibility of carrying out further controlled studies on a larger scale is limited by the high cost of the treatment, IVIg appears to be an effective therapy for refractory RA.