A case of malignant rheumatoid arthritis with long-term improvement by regular use of cryofiltration plasmapheresis
A Japanese man, 25 years old, suffered from stiffness, swelling, and pain of his joints in May 1983. He was diagnosed as rheumatoid arthritis and was given steroid unsuccessfully. Then, he was admitted to our hospital in February 1984. Because of the presence of high fever and rash on admission, differential diagnosis of RA from adult Stills disease was difficult. However, skin biopsy disclosed apparent vasculitis, leading to the definite diagnosis of malignant RA (MRA). We could not induce any remission by large dose of steroid including pulse therapy, various immuno-suppressants, and anti-rheumatic agents, because of lack of effectiveness and side effects of the drugs. Double filtration plasmapheresis (PA) was performed, but its beneficial effect soon disappeared. On the other hand, cryofiltration PA caused more beneficial and prolonged effect, resulting in improvement. Thereafter, he was successfully followed on regular use of PA for about 6 years. His condition depended on the interval between PA and next PA and on the volume of filtrated plasma. He died of septicemia on March, 1991. We report here the case of MRA with long time improvement by regular use of cryofiltration PA.