For Rheumatologists

Plasmapheresis in rheumatoid arthritis.

Plasmapheresis (PP) is used in the combined treatment of patients with rheumatoid arthritis (RA) during a period of exacerbation.

Indications:

1. Reduction of the activity of the inflammatory process.

2. Reduction of the elevated concentration of Ig, CIC and rheumatoid tests.

3.Reduction of the pain syndrome and of morning stiffness in the patient.

4. Improvement of blood microcirculation.

5.Reduction of the dose of corticosteroid and other medicinal preparations.

6.Increase of sensitivity to pharmacotherapy.

7.When switching from one basic drug to another.

Ревматологу — ілюстрація

Technique of performing plasmapheresis in rheumatoid arthritis:

A course of plasmapheresis consists of 3-4 procedures with an interval of 3 to 5 days.

The volumes of plasma removed per one PP are: at degree I of activity - 0,25 of the circulating plasma volume (CPV), at degree II of activity of the process - 0,5 CPV, at degree III of activity - 1 CPV.

PP is carried out in an isovolemic mode. The following are used as plasma-substituting solutions: isotonic sodium chloride solution (when removing 0,25 CPV); isotonic sodium chloride solution + ​​6% rheopolyglucin solution in a ratio of 2 : 1 (when removing 0,5 CPV); iso- 1J tonic sodium chloride solution + ​​protein solutions (FFP, 5% f albumin solution with replacement of 50-60% of the removed protein) (when removing 1 CPV). In the presence of signs of hypercoagulation, heparin is administered intravenously at a dose of 5-10 thousand IU before PP and, if indicated, 5 thousand IU -1 hour after the start of PP.

Efficacy criteria:

1. Improvement of the clinical and laboratory parameters.

2.Normalization of the number of CIC and of the disease activity indices, and a decrease in the Ig level.

3.Increase of the effectiveness of the basic treatment agents.