EVIDENCE FOR A THERAPEUTIC EFFECT OF PLASMAPHERESIS IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

  • 1 January 1979
    • journal article
    • research article
    • Vol. 48  (192) , 555-576
Abstract
Patients (14) with active systemic lupus erythematosus (SLE) were treated with plasmapheresis at a rate of 2 liters daily 3-4 days/wk, over a period of 2-3 wk. Plasma was replaced isovolemically with fresh frozen plasma or human plasma protein fractions. Ten patients were receiving treatment with prednisone at the time of plasmapheresis and 4 had received no prior treatment. Eight patients showed evidence of clinical improvement or clinical and immunochemical improvement at the time of plasmapheresis. In the 3 patients who showed high levels of circulating complexes before treatment, there was a sudden fall in level of circulating immune complexes, which was quantitatively greater than could be explained by the amount removed. In some patients with SLE, clearance of complexes by the mononuclear phagocytic system may be initially blocked by high levels of circulating complexes and one effect of plasmapheresis may be to relieve this blockade. Five patients showed a clinical response to plasmapheresis despite the fact that tests for immune complexes were negative. Three patients showed no response to plasmapheresis, and 3 were regarded as unevaluable. In a limited number of patients, who show a high level of circulating immune complexes and whose condition is deteriorating despite treatment with corticosteroids, there may be an important therapeutic role for plasmapheresis.