Clinical and laboratory variables and cytokine assay in monitoring the efficacy and safety of plasmapheresis in the treatment of active rheumatoid arthritis

Abstract EN

Methodology: This study included 41 active RA patients.

They were classified into two groups: Group I: Methotrexate (MTX) group included 21 patients (19 females and 2 males) and their mean age was 40.9 years.

All patients received oral MTX in a dose of 7.5-15 mg once per week.

Group II: Plasmapheresis (PP) group included 20 patients (18 females and 2 males) and their mean age was 46.5 years.

All patients in group I continued on MTX treatment for 24 consecutive weeks and all patients in Group II received 4 sessions of PP, two sessions per week with an interval of 3-4 days.

The amount of plasma removed from each patient should be 30 ml/kg per session.

Baseline and follow –up studies were scheduled until completion of 24 weeks of MTX therapy and before and after pp sessions.

All studied cases were subjected to careful history taking, clinical evaluation, laboratory variables, cytokine assay for the assessment of efficacy and safety.

Results: There was no significant difference between both groups either at the baseline or after treatment in all primary clinical variables while the statistical analysis of laboratory variables showed highly significant differences (p>0.001) in acute phase reactants in the PP Group including ESR and CRP with no significant differences in RF titer.

The number of seronegative patients showed a non-significant improvement with no statistically significant changes in serum level of total protein albumin and (Aspartame Amino transferrase (ALT) levels in both groups, while Alanine Amino transferrase (AST) level showed a little significant increased changes in both groups.

Overall comparison of the changes in serum cytokines after treatment in both MTX and PP groups showed no significant differences in serum levels of 1L-1B after treatment, although there was a significant decrease in both groups in comparison to baseline (p<0.1).

Meanwhile, we found a significant difference in serum levels of both TNF-? and IL-6 after treatment between both groups p<0.1 and p<0.002 respectively although there was a significant decrease in serum level of TNF-? and IL-6 after treatment in comparison to baseline; but it was more significant in MTX than PP Group.

As regard safety, our results developed minimal side effects in both groups in the form of mild gastrointestinal symptoms and elevated liver function tests in MTX Group and hypoproteinemia, hypocalcemia and hypotension in PP Group.