Background/Purpose:  Immunoadsorption been used in patients with severe refractory rheumatoid arthritis (RA) was first reported in 1994, and the efficacy is promising. However, the subset of RA patients most likely to benefit from immunoadsorption treatment has not been defined. At present, immunoadsorption is presented as an alternative try for serve RA patients with chronic infection who cannot use anti- tumor necrosis factor (TNF) agents. Today, neutralize TNF, including infliximab (IFX), are widely used in the treatments for patients with serve RA (DAS28-ESR>5.1). However, even treated with IFX, there still approximate 40% of serve RA patients cannot reach low disease activity. Till now, there has no study report the additional immunoadsorption efficacy besides IFX therapy in serve RA patients. In this study, we evaluated the efficacy of additional immunoadsorption therapy besides IFX on disease remission in patients with severe RA.

Methods: 30 patients with serve RA were included in this study. 20 patients were treated with basic infliximab 3 mg/kg + methotrexate (MTX) therapy, and other 10 patients, besides of basic therapy, were previous gave 2 times additional immunoadsorption therapy (to removal of immunoglobulin and other pathogenic factor). IFX 3 mg/kg was infused at weeks 0, 2, 6, 14, 22 and 30. Age, sex ration, mean disease duration, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Disease Activity Score including 28 joints using ESR (DAS28-ESR) from eligible patients in two treatment groups were collected at weeks 0, 2, 6, 14, 22 and 30 weeks and were compared between the two groups.

Results: The baseline age, sex ration, mean disease duration of RA, DAS28-ESR, ESR level and CRP level were comparable between the two treatment groups (P>0.05). At week 2 and week 6, decreases from baseline in DAS28-ESR, ESR and CRP were greater with additional immunoadsorption treatment group versus only IFX treatment group (Figure 1, P<0.05), and with the exception of ESR and CRP (Figure 1, P>0.05), these difference was generally maintained to week 30 (Figure 1, P<0.05). At week 2, the percentage of patients receiving additional immunoadsorption therapy who achieved improvements of DAS28-ESR (improvements >1.8) was 80%, which was higher than 60% in only IFX treatment group. At week 30, the percentage of patients receiving additional immunoadsorption therapy who achieved low disease activity or remission was 70%, which was also higher than 50% in only IFX treatment group.

Conclusion: Additional immunoadsorption therapy can rapid relive the disease activity of serve RA patients, and the remission rate of 30W was significantly higher than only IFX treatment. However, due to the limited sample size of this study, the efficacy of additional immunoadsorption needs further observations. Figure 1 Disease activity in patients with severe RA