The possibilities of extracorporal photopheresis in the complex treatment of rheumatoid arthritis

Abstract

The results of extracorporeal photopheresis in the complex treatment of rheumatoid arthritis are presented. It has been established that extracorporeal photopheresis procedures in combination with methotrexate basic therapy in patients with rheumatoid arthritis have a significant effect on arresting the articular syndrome (reducing morning stiffness, pain intensity, swelling of joints). It has been revealed that the inclusion of extracorporeal photopheresis in the complex therapy of rheumatoid arthritis reduces the humoral response (reduction of immunoglobulins A and G circulating high-molecular immune complexes) and in most cases leads to clinical and immunological remission. This is confirmed by a decrease in complaints about the severity of articular syndrome and a decrease in clinical and laboratory disease activity (a significant decrease in the level of C-reactive protein, erythrocyte sedimentation rate and fibrinogen). In addition, complex therapy of rheumatoid arthritis, including extracorporeal photopheresis, has a positive effect on the quality of life of patients, with the maximum improvement noted by the 12th month of therapy. Thus, in patients receiving complex therapy, indicators of physical and psychological health improved: physical functioning by 45%, role-based physical functioning by 52,7%, role-based emotional functioning by 11,5%, mental health by 35%, general health by 26%, social functioning by 24,5%, vital activity by 17%, and the intensity of the pain syndrome decreased by 34,6% compared to the pre-treatment rates. In general, complex therapy using extracorporal photopheresis lengthens the duration of remission of the disease and can be recommended for patients with rheumatoid arthritis with an insufficient effect of basic therapy and intolerance to higher doses of cytotoxic drugs.

Keywords

extracorporeal photopheresis / rheumatoid arthritis / basic therapy / articular syndrome / clinical laboratory index DAS 28crb / inflammatory markers / quality of life / immunomodulating therapy / cellular and humoral response / immune system

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RIGHTS & PERMISSIONS

Manuilov A.S., Belskih A.N., Bardakov S.N., Apchel A.V., Tishko V.V., Zakharov M.V., Sokolov A.A., Ryabova T.S., Volkov K.Yu., Kudryavtsev I.V., Serebriakova M.K., Trulyev A.S.