Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

Journal Article · Mon Aug 01 00:00:00 EDT 1983 · Arthritis Rheum.; (United States)

DOI:https://doi.org/10.1002/art.1780260801· OSTI ID:5476842

Field, E H; Strober, S; Hoppe, R T; Calin, A; Engleman, E G; Kotzin, B L; Tanay, A S; Calin, H J; Terrell, C P; Kaplan, H S

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 antiinflammatory 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 mononuclear 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.

• Research Organization: Department of Medicine, Stanford University School of Medicine, California
• OSTI ID: 5476842
• Journal Information: Arthritis Rheum.; (United States), Vol. 26:8
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
IMMUNOGLOBULINS
BIOSYNTHESIS
RHEUMATIC DISEASES
RADIOTHERAPY
ACETYLSALICYLIC ACID
ANTIHISTAMINICS
ANTINEOPLASTIC DRUGS
ANTIPYRETICS
CONCANAVALIN
GOLD COMPOUNDS
IMMUNOSUPPRESSIVE DRUGS
LYMPHATIC SYSTEM
LYMPHOCYTES
LYMPHOPENIA
PATIENTS
PENICILLAMINE
PHYTOHEMAGGLUTININ
RESPIRATORY SYSTEM DISEASES
SPLENOMEGALY
AGGLUTININS
AMINO ACIDS
ANALGESICS
ANIMAL CELLS
ANTIBODIES
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY FLUIDS
CARBOHYDRATES
CARBOXYLIC ACIDS
CENTRAL NERVOUS SYSTEM DEPRESSANTS
CHELATING AGENTS
CONNECTIVE TISSUE CELLS
DISEASES
DRUGS
GLOBULINS
HEMAGGLUTININS
HEMIC DISEASES
HYDROXY ACIDS
LEUKOCYTES
LEUKOPENIA
MATERIALS
MEDICINE
MITOGENS
MUCOPROTEINS
NUCLEAR MEDICINE
ORGANIC ACIDS
ORGANIC COMPOUNDS
ORGANIC SULFUR COMPOUNDS
PATHOLOGICAL CHANGES
POLYSACCHARIDES
PROTEINS
RADIOLOGY
RADIOPROTECTIVE SUBSTANCES
SACCHARIDES
SKELETAL DISEASES
SOMATIC CELLS
SYMPTOMS
SYNTHESIS
THERAPY
THIOLS
TRANSITION ELEMENT COMPOUNDS
550603* - Medicine- External Radiation in Therapy- (1980-)