Rheumatoid Vasculitis

Today, we cannot conclude comments on the treatment of immune-complex disease without paying our respects to therapeutic plasmapheresis and leukapheresis. Numerous centers are beginning to examine the value of removing either plasma or lymphocytes from patients with many rheumatic diseases. Efficacy appears to be established in hyperviscosity diseases (Waldenstrom's), myasthenia gravis, Goodpasture's syndrome, RH sensitized pregnant mothers, and thrombotic thrombocytopenic purpura. In active rheumatoid arthritis, it is a useful short-term tool but hardly cost effective. Although it would appear to be an advance from the medieval concept of purging out the "evil humors," pheresis for rheumatoid vasculitis must be considered a limited research tool, which may teach us something about mechanism of action. The mechanical removal of immune complexes by pheresis probably requires additional remittive or immunosuppressive therapy to prevent rebound in immune complex production. Effort now need to be directed to the agents that initiate production of immune complexes. Once the host's antibody system is so stimulated, we often find ourselves trying to close the barn door after the horse is long gone.