Journal article
Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation
Arthritis and rheumatism, Vol.26(8), pp.937-946
08/1983
DOI: 10.1002/art.1780260801
PMID: 6882488
Abstract
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 antiin‐flammatory 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 lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononu‐clear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values.
Details
- Title: Subtitle
- Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation
- Creators
- Elizabeth H FieldSamuel StroberRichard T HoppeAndrei CalinEdgar G EnglemanBrian L KotzinAmir S TanayH Jane CalinCandace P TerrellHenry S Kaplan
- Resource Type
- Journal article
- Publication Details
- Arthritis and rheumatism, Vol.26(8), pp.937-946
- DOI
- 10.1002/art.1780260801
- PMID
- 6882488
- NLM abbreviation
- Arthritis Rheum
- ISSN
- 0004-3591
- eISSN
- 1529-0131
- Publisher
- Wiley
- Number of pages
- 10
- Grant note
- National Institutes of Health (AI 11313) Kroc Foundation
- Language
- English
- Date published
- 08/1983
- Academic Unit
- Immunology; Internal Medicine
- Record Identifier
- 9984094502902771
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