Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

Journal Article · Mon Aug 01 04:00:00 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), Journal Name: Arthritis Rheum.; (United States) Vol. 26:8; ISSN ARHEA
• Country of Publication: United States
• Language: English

Related Subjects

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